D455 Professional Nursing Role Transition - Set 3 - Part 3

Correct Answer: I will eat more canned vegetables daily

Option c is correct because canned vegetables are high in sodium from the preservation process, which contributes to hypertension and worsens coronary artery disease progression, indicating the client needs further dietary education. Option a is incorrect because keeping a food diary is an effective accountability strategy that supports dietary behavior change and helps clients track sodium, fat, and caloric intake for coronary artery disease management goals. Option b is incorrect because walking thirty minutes daily provides cardiovascular conditioning that strengthens the heart, improves circulation, and helps manage weight, all of which slow coronary artery disease progression effectively. Option d is incorrect because oatmeal contains soluble fiber that actively reduces cholesterol levels, making it an excellent breakfast choice that directly supports the goal of slowing coronary artery disease atherosclerotic plaque formation.

Correct Answer: On the client's left unaffected side

Option a is correct because placing the commode on the unaffected left side allows the client to use their functional arm and leg for safe transfer, promoting independence while reducing fall risk during toileting. Option b is incorrect because placing the commode on the right affected side forces the client to rely on weakened or paralyzed extremities for transfer, significantly increasing the risk of falls and injury during toileting attempts. Option c is incorrect because positioning the commode at the foot of the bed requires the client to travel further and maneuver around the bed, creating unnecessary fall risk and increasing the physical demands of each transfer. Option d is incorrect because requiring the client to walk across the room to a bathroom significantly increases cardiac workload and fall risk, especially with right-sided hemiplegia that impairs balance and mobility.

Correct Answer: Stop the feeding and assess swallowing

Option d is correct because stroke clients with facial paralysis are at extreme aspiration risk, and giving fluids without first confirming intact swallow function could cause aspiration pneumonia or fatal airway obstruction requiring immediate intervention. Option a is incorrect because recommending thicker liquids without first performing a formal swallowing assessment assumes the client can safely swallow any consistency, which has not been established for this acute stroke patient. Option b is incorrect because documentation is important but secondary to the immediate safety concern of stopping the potentially dangerous oral intake that could cause aspiration in a client with unassessed swallow function. Option c is incorrect because while positioning affects swallowing safety, the first priority is stopping the active feeding attempt that poses immediate aspiration danger before addressing positioning or conducting any further assessments.

Correct Answer: Withhold both medications and notify provider

Option b is correct because metformin risks lactic acidosis with compromised perfusion and propranolol reduces cardiac contractility in acute decompensation, making both medications dangerous during acute heart failure requiring provider notification. Option a is incorrect because continuing both medications during acute heart failure places the client at risk for lactic acidosis from metformin and further cardiac depression from propranolol, both of which can be life-threatening. Option c is incorrect because propranolol should also be withheld during acute decompensated heart failure since beta-blockers reduce cardiac contractility and can worsen the already compromised cardiac output in this acute setting. Option d is incorrect because metformin should also be withheld since tissue perfusion is compromised in acute heart failure, dramatically increasing the risk of lactic acidosis, a potentially fatal metabolic complication from continued use.

Correct Answer: Maintain blood pressure below target this month

Option c is correct because this outcome is specific, measurable through blood pressure readings, and time-limited to the current month, meeting all criteria for appropriately written nursing care plan outcome statements. Option a is incorrect because feeling better is subjective and not objectively measurable, lacks a specific physiological parameter to evaluate, and does not provide a clear target that the healthcare team can assess. Option b is incorrect because trying to exercise is vague and not measurable, as it does not specify frequency, duration, or intensity of exercise and cannot be objectively evaluated for achievement of the goal. Option d is incorrect because reducing stress when possible lacks specificity, measurability, and a defined timeframe, making it impossible to objectively evaluate whether the client has achieved this poorly defined outcome.

Correct Answer: Intravenous administration for rapid onset

Option d is correct because gastrointestinal absorption is severely impaired in myxedema coma due to decreased metabolic function and bowel motility, mandating intravenous levothyroxine for reliable and rapid thyroid hormone delivery. Option a is incorrect because oral administration is unreliable in myxedema coma since the severe hypothyroid state dramatically impairs gastrointestinal absorption, making oral medication ineffective for this life-threatening emergency situation. Option b is incorrect because sublingual absorption, while bypassing first-pass metabolism, does not provide the reliable and rapid systemic delivery needed in the critical emergency setting of myxedema coma with compromised circulation. Option c is incorrect because intramuscular injection has unpredictable absorption in myxedema coma due to severely decreased peripheral circulation and tissue perfusion, making this route unreliable for emergency thyroid replacement.

Correct Answer: Syndrome of inappropriate ADH secretion

Option a is correct because weight gain, decreased concentrated urine output, and dilutional hyponatremia are the hallmark findings of SIADH, where excess antidiuretic hormone causes inappropriate water retention after neurosurgical procedures. Option b is incorrect because diabetes insipidus presents with the opposite findings including massive dilute urine output, dehydration, weight loss, and hypernatremia rather than the concentrated urine and hyponatremia seen here. Option c is incorrect because acute adrenal insufficiency involves cortisol deficiency with hypotension, hypoglycemia, and hyperkalemia as primary features rather than the fluid retention and concentrated urine pattern described in this scenario. Option d is incorrect because while mild postoperative fluid retention is common, a serum sodium of one hundred twenty-two with concentrated urine and weight gain represents a pathological condition requiring treatment rather than a normal expected finding.

Correct Answer: Ventricular arrhythmia from electrolyte shifts

Option b is correct because bilateral adrenalectomy causes rapid changes in cortisol and aldosterone levels leading to dangerous electrolyte shifts, particularly in potassium and sodium, which can trigger fatal ventricular arrhythmias postoperatively. Option a is incorrect because while glucose regulation changes after adrenalectomy, hypoglycemia from insulin resistance reversal is a gradual process rather than an immediately life-threatening complication in the acute postoperative period. Option c is incorrect because wound dehiscence, while a concern in clients with prolonged cortisol excess causing tissue fragility, is not the most immediately life-threatening complication compared to sudden cardiac rhythm disturbances postoperatively. Option d is incorrect because respiratory depression from anesthesia is a general postoperative concern for all surgical clients and is not the specific life-threatening complication uniquely associated with bilateral adrenalectomy and sudden hormone

Correct Answer: Educate about expected medication effects

Option c is correct because tachycardia, tremors, and shakiness are common pharmacological effects of albuterol as a beta-two agonist bronchodilator, and educating the client about these expected effects reduces anxiety and promotes adherence. Option a is incorrect because stopping the nebulizer for expected pharmacological effects would deprive the client of needed bronchodilation treatment and is not warranted when the symptoms represent the medication's known mechanism of action. Option b is incorrect because administering a beta-blocker would counteract the therapeutic bronchodilatory effect of albuterol and could cause bronchospasm in clients with underlying respiratory disease, creating a dangerous clinical situation. Option d is incorrect because the symptoms described are common and expected side effects of albuterol that do not represent an adverse reaction requiring urgent provider notification or intervention beyond routine client education.

Correct Answer: Stop metformin before the contrast procedure

Option d is correct because metformin combined with contrast dye significantly increases the risk of lactic acidosis due to potential renal impairment from the dye, requiring discontinuation before and typically forty-eight hours after the procedure. Option a is incorrect because doubling the metformin dose would increase drug concentration and dramatically raise the risk of lactic acidosis when combined with the nephrotoxic effects of contrast dye during cardiac catheterization. Option b is incorrect because continuing metformin without interruption before contrast dye exposure creates a dangerous combination that can precipitate lactic acidosis, a potentially fatal metabolic emergency in this clinical situation. Option c is incorrect because switching to insulin for one week before the procedure is unnecessarily complex and prolonged when the standard protocol simply requires holding metformin before and briefly after the contrast dye procedure.