The client makes which statement about lifestyle changes to reduce the development and progression of coronary artery disease that indicates the need for further teaching?

Correct Answer: D

Rationale: The client stating, 'As long as I exercise, stress at my job will not bother me,' indicates a misunderstanding of the relationship between exercise and stress management. It is important to clarify that while exercise can help reduce stress, it may not eliminate all stressors, especially those related to work. Further teaching is needed to ensure the client understands the multifactorial approach required to address stress and its impact on coronary artery disease.

Correct Answer: A

Rationale: When educating a client about the differences between angina and a myocardial infarction, it is crucial to emphasize key distinguishing factors. Angina typically improves with rest and is not usually life-threatening, whereas a myocardial infarction requires urgent intervention as it can be life-threatening. This explanation helps the client understand the urgency and severity associated with a myocardial infarction compared to angina.

Correct Answer: A

Rationale: ### **Comprehensive Rationale for the Correct Answer (A: Hemorrhagic Stroke)** **1. Correct Answer (A): Hemorrhagic Stroke** Thrombolytic medications (e.g., alteplase, tenecteplase) work by breaking down blood clots, which is beneficial in **ischemic strokes** (caused by blocked arteries). However, in a **hemorrhagic stroke**, bleeding occurs in or around the brain due to a ruptured blood vessel. Administering a thrombolytic in this scenario would **worsen bleeding** by inhibiting clotting mechanisms, leading to increased intracranial hemorrhage, higher morbidity, and potentially fatal outcomes. Thus, thrombolytics are **contraindicated** in hemorrhagic strokes, making **A the correct answer**. **2. Incorrect Answer (B): Thrombotic Stroke** A thrombotic stroke is a subtype of **ischemic stroke** caused by a clot obstructing blood flow in the brain. Thrombolytics are **first-line treatments** for ischemic strokes (if administered within the 3-4.5-hour window), as they dissolve clots and restore perfusion. Since this option incorrectly suggests that thrombotic strokes should **not** be treated with thrombolytics, it is **wrong**. **3. Incorrect Answer (C): Both Types Can Be Treated with a Thrombolytic** This choice falsely claims that thrombolytics are safe for **both** hemorrhagic and thrombotic strokes. While they are appropriate for **ischemic** (thrombotic/embolic) strokes, they **must never** be given in hemorrhagic strokes due to the risk of exacerbating bleeding. Thus, this option is **incorrect**. **4. Incorrect Answer (D): Neither Type Can Be Treated with a Thrombolytic** This option incorrectly asserts that **no strokes** should be treated with thrombolytics. While they are **contraindicated** in hemorrhagic strokes, they are **critical** in ischemic strokes when given promptly. Therefore, this choice is **false**. ### **Key Clinical Considerations:** - **Ischemic strokes (thrombotic/embolic)**: Thrombolytics are **lifesaving** if administered early (ideally within 3 hours, up to 4.5 hours in select cases). - **Hemorrhagic strokes**: Thrombolytics are **dangerous** and increase mortality—management focuses on controlling bleeding (e.g., BP control, surgical intervention). - **Imaging confirmation (CT/MRI)** is **essential** before thrombolytic administration to rule out hemorrhage. ### **Conclusion:** The **only correct answer is A (Hemorrhagic stroke)** because thrombolytics are **absolutely contraindicated** in bleeding strokes. The other options either misrepresent the use of thrombolytics in ischemic strokes (B, D) or incorrectly include hemorrhagic strokes as candidates (C). Proper stroke subtype diagnosis is **critical** before initiating therapy.

Correct Answer: D

Rationale: Nitroglycerin is known to cause headaches as a common side effect due to its vasodilatory properties. It dilates blood vessels, which can lead to headaches. While a headache can indicate other serious conditions, the most common association with nitroglycerin use is a headache. It is crucial for the nurse to recognize this side effect and provide appropriate education and support to the client.

Correct Answer: C

Rationale: Hyponatremia is not a common side effect associated with nitroglycerin use. Nitroglycerin typically causes side effects such as reflex tachycardia, dizziness, and hypotension due to its vasodilatory effects. Therefore, it is important for the nurse to educate the client about these potential side effects to promote understanding and appropriate management.