Prior to a cardiac catheterization, what is the most important action for the nurse to take?

Correct Answer: D

Rationale: The correct answer is D: Assess the client for any allergies, especially to iodine or shellfish. This is crucial because contrast dye containing iodine is commonly used during cardiac catheterization, and a client with allergies to iodine or shellfish can have a severe allergic reaction. It is essential to identify allergies beforehand to prevent any potential adverse reactions during the procedure. A: Ensuring NPO status is important for some procedures, but assessing for allergies is more critical to prevent life-threatening reactions. B: Administering pre-procedure medications is important, but assessing for allergies takes precedence to avoid allergic reactions. C: While obtaining informed consent is necessary, assessing for allergies is a crucial safety measure to prevent allergic reactions during the procedure.

Correct Answer: A

Rationale: The correct answer is A: Take prescribed antihypertensive medications regularly. This is the most important instruction for preventing another stroke because hypertension is a major risk factor for strokes. By controlling blood pressure with antihypertensive medications, the patient can significantly reduce the risk of another stroke. Engaging in physical therapy exercises (choice B) can be beneficial for overall recovery but is not as critical for stroke prevention as managing blood pressure. Following a low-fat, low-cholesterol diet (choice C) is important for heart health but not the most crucial for stroke prevention. Attending regular follow-up appointments (choice D) is essential for monitoring progress and adjusting treatment but does not directly prevent another stroke like managing hypertension does.

Correct Answer: B

Rationale: The correct answer is B: Assess the client's respiratory status. The first action should be to assess the client's respiratory status as the weight gain could indicate fluid retention leading to pulmonary congestion, a common complication in heart failure. By assessing the respiratory status, the nurse can determine if there are signs of respiratory distress such as increased work of breathing, crackles, or shortness of breath. This assessment will help in identifying any immediate need for interventions such as oxygen therapy or diuretics. Restricting fluid intake (choice A) is important but not the first step. Administering diuretics (choice C) should be based on assessment findings. Notifying the healthcare provider (choice D) can be done after assessing the client's respiratory status.

Correct Answer: D

Rationale: The correct answer is D: 15-20 grams of fast-acting carbohydrate orally. In hypoglycemia, the immediate goal is to raise blood glucose levels quickly. Fast-acting carbohydrates like glucose tablets or juice are the most effective and fastest way to raise blood sugar levels. Administering insulin (choice A) would further lower blood sugar levels. Intravenous dextrose (choice B) is appropriate for severe cases but may not be necessary as the first step. Glucagon (choice C) is typically used if the client is unconscious or unable to consume oral carbohydrates.

Correct Answer: B

Rationale: The correct answer is B, proper administration of insulin, because it is crucial for managing type 1 diabetes. Insulin is essential for regulating blood sugar levels in type 1 diabetes patients. Without proper insulin administration, the client's condition can deteriorate rapidly. Regular exercise (A) and a low-carbohydrate diet (C) are important aspects of diabetes management, but they are not as critical as ensuring proper insulin administration. Recognizing signs of hyperglycemia (D) is important, but knowing how to administer insulin correctly takes precedence in effectively managing type 1 diabetes.