ALL LaCharity Chapters with complete solution
1. You are working in the emergency department (ED) when a client arrives
reporting substernal and left arm discomfort that has been going on for about 3
hours. Which laboratory test will be most useful in determining whether you
should anticipate implementing the acute coronary syndrome (ACS) standard
protocol?
1. Creatine kinase MB level
2. Troponin I level
3. Myoglobin level
4. C-reactive protein level
1. Ans: 2. Troponin I level
Cardiac troponin levels are elevated 3 hours after the onset of ACS (unstable angina or
myocardial infarction [MI]) and are very specific to cardiac muscle injury or infarction.
Although levels of creatine kinase MB and myoglobin also increase with MI, the
increases occur later and/or are not as specific to myocardial damage as troponin
levels. Elevated C-reactive protein levels are a risk factor for coronary artery disease
but are not useful in detecting acute injury or infarction. Focus: Prioritization
2. You are monitoring a 53-year-old client who is undergoing a treadmill stress
test. Which client finding will require the most immediate action?
1. Blood pressure of 152/88 mm Hg
2. Heart rate of 134 beats/min
3. Oxygen saturation of 91%
4. Chest pain level of 3 (on a scale of 10)
2. Ans: 4. Chest pain level of 3 (on a scale of 10)
Chest pain in a client undergoing a stress test indicates myocardial ischemia and is an
indication to stop the testing to avoid ongoing ischemia, injury, or infarction. Moderate
elevations in blood pressure and heart rate and slight decreases in oxygen saturation
are a normal response to exercise and are expected during stress testing. Focus:
Prioritization
3. The health care provider prescribes these actions for a client who was admitted
with acute substernal chest pain. Which actions are appropriate to delegate to an
experienced LPN/LVN who is working with you in the ED? (Select all that apply.)
1. Attaching cardiac monitor leads
2. Giving heparin 5000 units IV push
3. Administering morphine sulfate 4 mg IV
4. Obtaining a 12-lead electrocardiogram (ECG)
5. Asking the client about pertinent medical history
6. Having the client chew and swallow aspirin 162 mg
3. Ans: 1, 4, 6
1. Attaching cardiac monitor leads
,4. Obtaining a 12-lead electrocardiogram (ECG)
6. Having the client chew and swallow aspirin 162 mg
Attaching cardiac monitor leads, obtaining an ECG, and administering oral medications
are within the scope of practice for LPN/LVNs. An experienced ED LPN/LVN would be
familiar with these activities. Although anticoagulants and narcotics may be
administered by LPNs/LVNs to stable clients, these are high-alert medications that
should be given by the RN to this unstable client. Obtaining a pertinent medical history
requires RN-level education and scope of practice. Focus: Delegation
4. Based on this information in a client's medical record, which topic will you plan
on including in the initial teaching plan for a client who has a new diagnosis of
stage 1 hypertension?
Health History- Denies any chronic health problems, currently takes no
medications. Physical Exam- 5'6" , 115lbs, BMI 18.6. Social and Diet HX-
Accountant, 1 glass of wine 1-2 times week, Eats fast food frequently.
1. Benefits and adverse effects of beta-blockers
2. Adverse effects of alcohol on blood pressure
3. Methods for decreasing dietary caloric intake
4. Low-sodium food choices when eating out
4. Ans: 4. Low-sodium food choices when eating out
Research indicates that reducing sodium intake will lower blood pressure. Lifestyle
management is appropriate initial therapy for this client with stage 1 hypertension and
no cardiovascular disease or risk factors. Antihypertensive medications would not be
prescribed unless lifestyle changes were attempted for several months without a
decrease in blood pressure. This client's assessment data indicate that she is not
overweight and does not drink alcohol excessively, so discussing changes in these risk
factors would not be appropriate. Focus: Prioritization
5. You make a home visit to evaluate a hypertensive client who has been taking
enalapril (Vasotec). Which finding indicates that you need to contact the health
care provider about a change in the drug therapy?
1. Client reports frequent urination.
2. Client's blood pressure is 138/86 mm Hg.
3. Client coughs often during the visit.
4. Client says, "I get dizzy sometimes."
5. Ans: 3. Client coughs often during the visit.
A persistent and irritating cough (caused by accumulation of bradykinin) is a possible
adverse effect of angiotensin-converting enzyme (ACE) inhibitors such as enalapril and
is a common reason for changing to another medication category such as the
angiotensin II receptor blockers. The other assessment data indicate a need for more
client teaching and ongoing monitoring but would not require a change in therapy.
Focus: Prioritization
,6. While admitting a client, you obtain this information about her cardiovascular
risk factors: Her mother and two siblings have had myocardial infarctions (MIs).
The client smokes and has a 20 pack-year history of cigarette use. Her work as a
mail carrier involves a lot of walking. She takes metoprolol (Lopressor) for
hypertension, and her blood pressure has been in the range of 130/60 to 138/85
mm Hg. Which interventions will be important to include in the discharge plan for
this client? (Select all that apply.)
1. Referral to community programs that assist in smoking cessation
2. Teaching about the impact of family history on cardiovascular risk
3. Education about the need for a change in antihypertensive therapy
4. Assistance in reducing the stress associated with her cardiovascular risk
5. Discussion of the risks associated with having a sedentary lifestyle
6. Ans: 1, 2
1. Referral to community programs that assist in smoking cessation
2. Teaching about the impact of family history on cardiovascular risk
The client's major modifiable risk factor is her ongoing smoking. The family history is
significant, and she should be aware that this increases her cardiovascular risk. The
goal when treating hypertension with medications is reduction of blood pressure to
under 140/90 mm Hg. There is no indication that stress is a risk factor for this client. The
client's work involves moderate physical activity; although leisure exercise may further
decrease her cardiac risk, this is not an immediate need for this client. Focus:
Prioritization
7. You are the charge nurse for the coronary care step-down unit. Which client is
best to assign to a float RN who has come for the day from the general medical-
surgical unit?
1. Client requiring discharge teaching about coronary artery stenting before
going home today
2. Client receiving IV furosemide (Lasix) to treat acute left ventricular failure
3. Client who just transferred in from the radiology department after a coronary
angioplasty
4. Client just admitted with unstable angina who has orders for a heparin infusion
and aspirin
7. Ans: 2. Client receiving IV furosemide (Lasix) to treat acute left ventricular failure
An RN who worked on a medical-surgical unit would be familiar with left ventricular
failure, the administration of IV medications, and ongoing monitoring for therapeutic and
adverse effects of furosemide. The other clients need to be cared for by RNs who are
more familiar with the care of clients who have ACS and with collaborative treatments
such as coronary angioplasty and coronary artery stenting. Focus: Assignment
8. At 9:00 pm, you admit a 63-year-old with a diagnosis of acute MI. Which finding
is most important to communicate to the health care provider who is considering
the use of fibrinolytic therapy with tissue plasminogen activator (alteplase
[Activase]) for the client?
, 1. The client was treated with alteplase about 8 months ago.
2. The client takes famotidine (Pepcid) for esophageal reflux.
3. The client has ST-segment elevations on the 12-lead ECG.
4. The client has had continuous chest pain since 8:00 AM.
8. Ans: 4. The client has had continuous chest pain since 8:00 AM.
Because continuous chest pain lasting for more than 12 hours indicates that reversible
myocardial injury has progressed to irreversible myocardial necrosis, fibrinolytic drugs
are not recommended for clients with chest pain that has lasted for more than 12 hours.
The other information is also important to communicate but would not impact the
decision about alteplase use. Focus: Prioritization
9. You are working with an experienced UAP and an LPN/LVN on the telemetry
unit. A client who had an acute MI 3 days ago has a nursing diagnosis of Activity
Intolerance related to fatigue and chest pain. Which nursing activity included in
the care plan is best delegated to the LPN/LVN?
1. Administering nitroglycerin (Nitrostat) if chest discomfort occurs during client
activities
2. Monitoring pulse, blood pressure, and oxygen saturation before and after client
ambulation
3. Teaching the client energy conservation techniques to decrease myocardial
oxygen demand
4. Explaining the rationale for alternating rest periods with exercise to the client
and family
9. Ans: 1. Administering nitroglycerin (Nitrostat) if chest discomfort occurs during client
activities
Administration of nitroglycerin and appropriate client monitoring for therapeutic and
adverse effects are included in LPN/LVN education and scope of practice. Monitoring of
blood pressure, pulse, and oxygen saturation should be delegated to the UAP. Client
teaching requires RN-level education and scope of practice. Focus: Delegation
10. You are working in the ED caring for a client who was just admitted with left
anterior chest pain, possible ACS. Which action will you take first?
1. Insert an IV catheter.
2. Auscultate heart sounds.
3. Administer sublingual nitroglycerin.
4. Draw blood for troponin I measurement.
10. Ans: 3. Administer sublingual nitroglycerin.
The priority for a client with unstable angina or MI is treatment of pain. It is important to
remember to assess vital signs before administering sublingual nitroglycerin. The other
activities also should be accomplished rapidly but are not as high a priority. Focus:
Prioritization
1. You are working in the emergency department (ED) when a client arrives
reporting substernal and left arm discomfort that has been going on for about 3
hours. Which laboratory test will be most useful in determining whether you
should anticipate implementing the acute coronary syndrome (ACS) standard
protocol?
1. Creatine kinase MB level
2. Troponin I level
3. Myoglobin level
4. C-reactive protein level
1. Ans: 2. Troponin I level
Cardiac troponin levels are elevated 3 hours after the onset of ACS (unstable angina or
myocardial infarction [MI]) and are very specific to cardiac muscle injury or infarction.
Although levels of creatine kinase MB and myoglobin also increase with MI, the
increases occur later and/or are not as specific to myocardial damage as troponin
levels. Elevated C-reactive protein levels are a risk factor for coronary artery disease
but are not useful in detecting acute injury or infarction. Focus: Prioritization
2. You are monitoring a 53-year-old client who is undergoing a treadmill stress
test. Which client finding will require the most immediate action?
1. Blood pressure of 152/88 mm Hg
2. Heart rate of 134 beats/min
3. Oxygen saturation of 91%
4. Chest pain level of 3 (on a scale of 10)
2. Ans: 4. Chest pain level of 3 (on a scale of 10)
Chest pain in a client undergoing a stress test indicates myocardial ischemia and is an
indication to stop the testing to avoid ongoing ischemia, injury, or infarction. Moderate
elevations in blood pressure and heart rate and slight decreases in oxygen saturation
are a normal response to exercise and are expected during stress testing. Focus:
Prioritization
3. The health care provider prescribes these actions for a client who was admitted
with acute substernal chest pain. Which actions are appropriate to delegate to an
experienced LPN/LVN who is working with you in the ED? (Select all that apply.)
1. Attaching cardiac monitor leads
2. Giving heparin 5000 units IV push
3. Administering morphine sulfate 4 mg IV
4. Obtaining a 12-lead electrocardiogram (ECG)
5. Asking the client about pertinent medical history
6. Having the client chew and swallow aspirin 162 mg
3. Ans: 1, 4, 6
1. Attaching cardiac monitor leads
,4. Obtaining a 12-lead electrocardiogram (ECG)
6. Having the client chew and swallow aspirin 162 mg
Attaching cardiac monitor leads, obtaining an ECG, and administering oral medications
are within the scope of practice for LPN/LVNs. An experienced ED LPN/LVN would be
familiar with these activities. Although anticoagulants and narcotics may be
administered by LPNs/LVNs to stable clients, these are high-alert medications that
should be given by the RN to this unstable client. Obtaining a pertinent medical history
requires RN-level education and scope of practice. Focus: Delegation
4. Based on this information in a client's medical record, which topic will you plan
on including in the initial teaching plan for a client who has a new diagnosis of
stage 1 hypertension?
Health History- Denies any chronic health problems, currently takes no
medications. Physical Exam- 5'6" , 115lbs, BMI 18.6. Social and Diet HX-
Accountant, 1 glass of wine 1-2 times week, Eats fast food frequently.
1. Benefits and adverse effects of beta-blockers
2. Adverse effects of alcohol on blood pressure
3. Methods for decreasing dietary caloric intake
4. Low-sodium food choices when eating out
4. Ans: 4. Low-sodium food choices when eating out
Research indicates that reducing sodium intake will lower blood pressure. Lifestyle
management is appropriate initial therapy for this client with stage 1 hypertension and
no cardiovascular disease or risk factors. Antihypertensive medications would not be
prescribed unless lifestyle changes were attempted for several months without a
decrease in blood pressure. This client's assessment data indicate that she is not
overweight and does not drink alcohol excessively, so discussing changes in these risk
factors would not be appropriate. Focus: Prioritization
5. You make a home visit to evaluate a hypertensive client who has been taking
enalapril (Vasotec). Which finding indicates that you need to contact the health
care provider about a change in the drug therapy?
1. Client reports frequent urination.
2. Client's blood pressure is 138/86 mm Hg.
3. Client coughs often during the visit.
4. Client says, "I get dizzy sometimes."
5. Ans: 3. Client coughs often during the visit.
A persistent and irritating cough (caused by accumulation of bradykinin) is a possible
adverse effect of angiotensin-converting enzyme (ACE) inhibitors such as enalapril and
is a common reason for changing to another medication category such as the
angiotensin II receptor blockers. The other assessment data indicate a need for more
client teaching and ongoing monitoring but would not require a change in therapy.
Focus: Prioritization
,6. While admitting a client, you obtain this information about her cardiovascular
risk factors: Her mother and two siblings have had myocardial infarctions (MIs).
The client smokes and has a 20 pack-year history of cigarette use. Her work as a
mail carrier involves a lot of walking. She takes metoprolol (Lopressor) for
hypertension, and her blood pressure has been in the range of 130/60 to 138/85
mm Hg. Which interventions will be important to include in the discharge plan for
this client? (Select all that apply.)
1. Referral to community programs that assist in smoking cessation
2. Teaching about the impact of family history on cardiovascular risk
3. Education about the need for a change in antihypertensive therapy
4. Assistance in reducing the stress associated with her cardiovascular risk
5. Discussion of the risks associated with having a sedentary lifestyle
6. Ans: 1, 2
1. Referral to community programs that assist in smoking cessation
2. Teaching about the impact of family history on cardiovascular risk
The client's major modifiable risk factor is her ongoing smoking. The family history is
significant, and she should be aware that this increases her cardiovascular risk. The
goal when treating hypertension with medications is reduction of blood pressure to
under 140/90 mm Hg. There is no indication that stress is a risk factor for this client. The
client's work involves moderate physical activity; although leisure exercise may further
decrease her cardiac risk, this is not an immediate need for this client. Focus:
Prioritization
7. You are the charge nurse for the coronary care step-down unit. Which client is
best to assign to a float RN who has come for the day from the general medical-
surgical unit?
1. Client requiring discharge teaching about coronary artery stenting before
going home today
2. Client receiving IV furosemide (Lasix) to treat acute left ventricular failure
3. Client who just transferred in from the radiology department after a coronary
angioplasty
4. Client just admitted with unstable angina who has orders for a heparin infusion
and aspirin
7. Ans: 2. Client receiving IV furosemide (Lasix) to treat acute left ventricular failure
An RN who worked on a medical-surgical unit would be familiar with left ventricular
failure, the administration of IV medications, and ongoing monitoring for therapeutic and
adverse effects of furosemide. The other clients need to be cared for by RNs who are
more familiar with the care of clients who have ACS and with collaborative treatments
such as coronary angioplasty and coronary artery stenting. Focus: Assignment
8. At 9:00 pm, you admit a 63-year-old with a diagnosis of acute MI. Which finding
is most important to communicate to the health care provider who is considering
the use of fibrinolytic therapy with tissue plasminogen activator (alteplase
[Activase]) for the client?
, 1. The client was treated with alteplase about 8 months ago.
2. The client takes famotidine (Pepcid) for esophageal reflux.
3. The client has ST-segment elevations on the 12-lead ECG.
4. The client has had continuous chest pain since 8:00 AM.
8. Ans: 4. The client has had continuous chest pain since 8:00 AM.
Because continuous chest pain lasting for more than 12 hours indicates that reversible
myocardial injury has progressed to irreversible myocardial necrosis, fibrinolytic drugs
are not recommended for clients with chest pain that has lasted for more than 12 hours.
The other information is also important to communicate but would not impact the
decision about alteplase use. Focus: Prioritization
9. You are working with an experienced UAP and an LPN/LVN on the telemetry
unit. A client who had an acute MI 3 days ago has a nursing diagnosis of Activity
Intolerance related to fatigue and chest pain. Which nursing activity included in
the care plan is best delegated to the LPN/LVN?
1. Administering nitroglycerin (Nitrostat) if chest discomfort occurs during client
activities
2. Monitoring pulse, blood pressure, and oxygen saturation before and after client
ambulation
3. Teaching the client energy conservation techniques to decrease myocardial
oxygen demand
4. Explaining the rationale for alternating rest periods with exercise to the client
and family
9. Ans: 1. Administering nitroglycerin (Nitrostat) if chest discomfort occurs during client
activities
Administration of nitroglycerin and appropriate client monitoring for therapeutic and
adverse effects are included in LPN/LVN education and scope of practice. Monitoring of
blood pressure, pulse, and oxygen saturation should be delegated to the UAP. Client
teaching requires RN-level education and scope of practice. Focus: Delegation
10. You are working in the ED caring for a client who was just admitted with left
anterior chest pain, possible ACS. Which action will you take first?
1. Insert an IV catheter.
2. Auscultate heart sounds.
3. Administer sublingual nitroglycerin.
4. Draw blood for troponin I measurement.
10. Ans: 3. Administer sublingual nitroglycerin.
The priority for a client with unstable angina or MI is treatment of pain. It is important to
remember to assess vital signs before administering sublingual nitroglycerin. The other
activities also should be accomplished rapidly but are not as high a priority. Focus:
Prioritization
