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A 24-year-old man seeks medical attention for complaints of claudication in the
arch of the foot. The nurse also notes superficial thrombophlebitis of the lower
leg. The nurse should check the client for which next?
1. Smoking history
2. Recent exposure to allergens
3. History of recent insect bites
4. Familial tendency toward peripheral vascular disease Correct Answer: 1.
Smoking history
The nurse has reinforced instructions to the client with Raynaud's disease about
self-management of the disease process. The nurse determines that the client
needs further teaching if the client states which?
1. "Smoking cessation is very important."
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,2. "Moving to a warmer climate should help."
3. "Sources of caffeine should be eliminated from the diet."
4. "Taking nifedipine (Procardia) as prescribed will decrease vessel spasm."
Correct Answer: 2. "Moving to a warmer climate should help."
A client with myocardial infarction suddenly becomes tachycardic, shows signs
of air hunger, and begins coughing frothy, pink-tinged sputum. The nurse listens
to breath sounds, expecting to hear which breath sounds bilaterally?
1. Rhonchi
2. Crackles
3. Wheezes
4. Diminished breath sounds Correct Answer: 2. Crackles
The LPN/LVN is collecting data on a client with a diagnosis of right- sided
heart failure. The nurse should expect to note which specific characteristic of
this condition?
1. Dyspnea
2. Hacking cough
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,3. Dependent edema
4. Crackles on lung auscultation Correct Answer: 3. Dependent edema
The LPN/LVN is preparing to ambulate a postoperative client after cardiac
surgery. The nurse plans to do which to enable the client to best tolerate the
ambulation?
1. Provide the client with a walker.
2. Remove the telemetry equipment.
3. Encourage the client to cough and deep breathe.
4. Premedicate the client with an analgesic before ambulating.
Correct Answer: 4. Premedicate the client with an analgesic before ambulating.
A client is wearing a continuous cardiac monitor, which begins to alarm at the
nurse's station. The nurse sees no electrocardiographic complexes on the screen.
The nurse should do which first?
1. Call a code blue.
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, 2. Call the health care provider.
3. Check the client status and lead placement.
4. Press the recorder button on the ECG console.
Correct Answer: 3. Check the client status and lead placement.
The LPN/LVN in a medical unit is caring for a client with heart failure. The
client suddenly develops extreme dyspnea, tachycardia, and lung crackles, and
the nurse suspects pulmonary edema. The nurse immediately notifies the
registered nurse and expects which interventions to be prescribed? Select all
that apply.
1. Administering oxygen
2. Inserting a Foley catheter
3. Administering furosemide (Lasix)
4. Administering morphine sulfate intravenously
5. Transporting the client to the coronary care unit
6. Placing the client in a low-Fowler's side-lying position
Correct Answer:
1. Administering oxygen
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