Which statement, made by the client with coronary artery disease, alerts the nurse that the client may be experiencing difficulty adapting to the illness?

"I feel a little anxious when I get chest discomfort."

"I know that I should carry my medication with me in case I develop chest pain."

"My wife and I will learn to cook using the 'good' cooking oils."

"I usually wait about two hours after I feel chest discomfort to seek medical attention."

Answer and Explanation

The Correct Answer is D

Choice A reason: This is not an alarming statement. Feeling a little anxious when experiencing chest discomfort is a normal and understandable reaction. Chest discomfort can be a sign of angina, which is a condition where the heart muscle does not get enough oxygen due to reduced blood flow. Angina can cause pain, pressure, or tightness in the chest, and can be triggered by physical or emotional stress. The client should try to relax and take their medication as prescribed to relieve the discomfort.

Choice B reason: This is not an alarming statement. Knowing that they should carry their medication with them in case they develop chest pain is a sign of good self-care and awareness. The client should have a quick-relief medication, such as nitroglycerin, that can dilate the coronary arteries and improve the blood flow to the heart. The client should take the medication as soon as they feel chest pain and follow the instructions on how to use it.

Choice C reason: This is not an alarming statement. Learning to cook using the "good" cooking oils is a sign of positive lifestyle change and adaptation. The client should avoid or limit the intake of saturated and trans fats, which can raise the level of low-density lipoprotein (LDL) cholesterol in the blood. LDL cholesterol is also known as the "bad" cholesterol because it can deposit on the walls of the arteries and cause atherosclerosis, which is the narrowing and hardening of the arteries. The client should use unsaturated fats, such as olive oil, canola oil, or sunflower oil, which can lower the LDL cholesterol and increase the high-density lipoprotein (HDL) cholesterol. HDL cholesterol is also known as the "good" cholesterol because it can remove the excess cholesterol from the arteries and transport it to the liver.

Choice D reason: This is the alarming statement. Waiting about two hours after feeling chest discomfort to seek medical attention is a sign of denial and delay. Chest discomfort can be a symptom of a heart attack, which is a life-threatening emergency where the blood flow to the heart is blocked and the heart muscle begins to die. The client should seek immediate medical attention if they experience chest pain that lasts more than a few minutes, or if it is accompanied by other signs, such as shortness of breath, nausea, sweating, or arm or jaw pain. The sooner the client receives treatment, the better the chance of survival and recovery.

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Correct Answer is A

Explanation

Choice A reason: The client had an allergic reaction to losartan, a drug that belongs to the class of angiotensin II receptor blockers (ARBs). ¹ Anaphylaxis is a severe and potentially life-threatening allergic reaction that can cause swelling of the lips, tongue, throat, and face, as well as difficulty breathing, low blood pressure, and shock. ² The client needs immediate medical attention and treatment with oxygen, fluids, and epinephrine. ³

Choice B reason: The client did not have an expected side effect of the medication. Losartan is used to treat high blood pressure and heart failure by blocking the action of angiotensin II, a hormone that causes blood vessels to constrict and retain salt and water. ¹ Some common side effects of losartan include dizziness, headache, fatigue, cough, and nausea. ⁴ Anaphylaxis is not a common or expected side effect of losartan, but a rare and serious adverse reaction.

Choice C reason: The client should not have a prescription change to enalapril. Enalapril is another drug that lowers blood pressure and heart failure, but it belongs to the class of angiotensin-converting enzyme (ACE) inhibitors. ⁵ ACE inhibitors and ARBs have similar mechanisms of action and effects, but they differ in how they block the angiotensin system. However, both classes of drugs can cause allergic reactions and anaphylaxis in some people, especially those who have a history of allergy to either drug. The client should avoid both ACE inhibitors and ARBs and use another type of blood pressure medication.

Choice D reason: The client should not avoid taking the medication with food. Food does not affect the absorption or effectiveness of losartan. ⁴ The client can take the medication with or without food, as directed by the provider. However, the client should avoid grapefruit and grapefruit juice, as they can interact with losartan and increase the risk of side effects.

A. Have analgesic properties without sedation B. Can trigger vasodilation and improve blood flow C. Improve contractility and decrease afterload D. Inhibit platelet aggregation and clot formation

Correct Answer is A

Explanation

Choice A reason: Having analgesic properties without sedation is not the rationale for prescribing aspirin and clopidogrel for coronary artery disease. Aspirin and clopidogrel are antiplatelet drugs that prevent blood clots from forming in the arteries that supply the heart. They do not have significant analgesic or sedative effects.

Choice B reason: Triggering vasodilation and improving blood flow is not the rationale for prescribing aspirin and clopidogrel for coronary artery disease. Aspirin and clopidogrel do not directly cause vasodilation or increase blood flow. They work by reducing the stickiness of platelets and preventing them from clumping together and blocking the arteries.

Choice C reason: Improving contractility and decreasing afterload is not the rationale for prescribing aspirin and clopidogrel for coronary artery disease. Aspirin and clopidogrel do not affect the contractility or the afterload of the heart. They act on the blood vessels and the blood cells, not on the heart muscle. Contractility and afterload are influenced by other drugs such as beta-blockers, calcium channel blockers, and angiotensin-converting enzyme inhibitors.

Choice D reason: This is the correct answer. Inhibiting platelet aggregation and clot formation is the rationale for prescribing aspirin and clopidogrel for coronary artery disease. Aspirin and clopidogrel are antiplatelet drugs that interfere with the function of platelets, which are blood cells that help with clotting. By inhibiting platelet aggregation and clot formation, aspirin and clopidogrel reduce the risk of heart attack and stroke in people with coronary artery disease.

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Which statement, made by the client with coronary artery disease, alerts the nurse that the client may be experiencing difficulty adapting to the illness?

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Correct Answer is A

Explanation

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Correct Answer is A

Explanation

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