Which of the points should a nurse include in the discharge teaching plan for a client after cardiac surgery?

Correct Answer: D

Rationale: In the context of discharge teaching after cardiac surgery, the nurse should include information about when sexual relations can be resumed as it is crucial for the patient's post-operative recovery. Option D is correct because it provides a specific timeframe of 2 to 4 weeks, which aligns with the typical recovery period and allows for gradual resumption of normal activities. Option A is incorrect because showering is usually allowed after cardiac surgery once incisions are healed to prevent infections. Option B is incorrect as a painless lump at the top of the chest incision is not a common post-operative concern and should not be the primary focus of discharge teaching. Option C is also incorrect as support hose or elastic stockings are typically recommended to be worn during the day to prevent edema and promote circulation, not just at night. Educationally, understanding the timing of resuming sexual activity post-cardiac surgery is essential for patient safety and optimal recovery. It ensures that patients are aware of the appropriate timeline and can prevent complications or unnecessary stress during their recovery process.

Correct Answer: A

Rationale: The correct answer is A) assess the patient's perception of the event with open-ended questions. This is the most effective action because it allows the nurse to understand the patient's perspective, concerns, and beliefs regarding their diagnosis. By using open-ended questions, the nurse can engage in a meaningful dialogue with the patient, which can help build rapport and trust. Option B) presenting research to support the need for risk-factor reduction may not be as effective in this scenario because the patient's resistance seems to stem from their perception and feelings rather than a lack of information. Providing research may come off as dismissive of the patient's emotions. Option C) reinforcing patient education could be premature without first addressing the patient's emotional response and understanding their perspective. It is essential to address the patient's concerns before providing further education. Option D) reviewing the laboratory values with the patient may not address the underlying emotional and psychological aspects of the patient's response to their diagnosis. Understanding the patient's emotional state is crucial before delving into medical details. In an educational context, this scenario highlights the importance of patient-centered care and the need for healthcare providers to acknowledge and address patients' emotions and beliefs when providing care. Effective communication and empathy are key components of building a therapeutic relationship with patients, especially in challenging situations like a myocardial infarction diagnosis.

Correct Answer: B

Rationale: The correct answer is B) Holter monitoring. Holter monitoring is used to evaluate ECG responses to normal activity over an extended period, usually 1 or 2 days. This method allows for continuous monitoring of the heart's electrical activity during daily activities, providing a more comprehensive assessment compared to a single ECG. Option A) Serial ECGs involve taking multiple ECG readings at different time points but do not provide continuous monitoring over an extended period like Holter monitoring. Option C) The 6-minute walk test is a measure of exercise capacity and functional status, not a method for continuous ECG monitoring. Option D) Event monitors or loop recorders are used for intermittent monitoring to capture specific cardiac events or symptoms, not for continuous monitoring over 1 or 2 days like Holter monitoring. In an educational context, understanding the different methods of cardiac monitoring is crucial for healthcare professionals, especially those working in cardiology or primary care settings. Knowing when to use each method based on the patient's symptoms and clinical presentation is essential for accurate diagnosis and appropriate management of cardiovascular conditions. Holter monitoring plays a specific role in assessing cardiac rhythm disturbances that may occur during daily activities, providing valuable information for diagnosis and treatment planning.

Correct Answer: D

Rationale: In the treatment of hypertensive crises, the most commonly used drugs are fenoldopam (Corlopam) and sodium nitroprusside (Nipride) as indicated by option D. Fenoldopam is a selective dopamine receptor agonist that promotes vasodilation, helping to reduce blood pressure quickly. Sodium nitroprusside is a potent vasodilator that acts on both arteries and veins, rapidly lowering blood pressure in emergency situations. Option A, Esmolol and captopril, are not typically used in hypertensive crises. Esmolol is a beta-blocker that acts more for long-term blood pressure control, while captopril is an ACE inhibitor that may take longer to show its full effect. Option B, Enalaprilat and minoxidil, are also not the first-line agents for hypertensive crises. Enalaprilat is an ACE inhibitor, similar to captopril, and minoxidil is a potent vasodilator that is more commonly used for chronic hypertension. Option C, Labetalol and bumetanide, are used in hypertensive emergencies, but they are not the most commonly used drugs for this purpose. Labetalol is a combined alpha and beta-blocker, and bumetanide is a loop diuretic, which are not the primary choices for immediate blood pressure reduction. It is crucial for healthcare professionals to be well-versed in the appropriate medications for hypertensive crises to ensure prompt and effective management of potentially life-threatening situations. Understanding the mechanisms of action and indications of each drug is essential for providing optimal patient care in emergency situations.

Correct Answer: A

Rationale: The correct answer is A) To lie or sit and place one tablet under the tongue when chest pain occurs. This is the correct instruction for taking sublingual nitroglycerin tablets because sublingual administration allows for rapid absorption of the medication into the bloodstream, providing quick relief for angina symptoms. Placing the tablet under the tongue helps facilitate this rapid absorption. Option B is incorrect because taking the tablet with a large amount of water would not allow for sublingual absorption and would delay the onset of action. Option C is incorrect because if the chest pain persists after taking one tablet, the patient should take a second tablet after 5 minutes and seek emergency medical assistance if the pain is still not relieved, rather than waiting 15 minutes to go to the hospital. Option D is incorrect because dizziness and headache are common side effects of nitroglycerin and do not necessarily indicate a need to stop the medication; the patient should be advised to sit or lie down and wait for the symptoms to subside. In an educational context, it is important for nurses to provide clear and accurate instructions to patients regarding the administration of sublingual nitroglycerin to ensure optimal effectiveness in relieving angina symptoms. Educating patients on the correct administration technique can help improve outcomes and patient safety in managing cardiovascular conditions.