A client who has had a significant myocardial infarction receives a referral to the cardiac rehabilitation unit. During his first visit to the unit, he tells the nurse that he doesn't understand why he needs to be there because there is nothing more to do as the damage is done. Which of the following responses should the nurse make?
"Cardiac rehabilitation cannot undo the damage to your heart, but it can help you get back to your previous level of activity safely."
"Your doctor is the expert here, and I'm sure he would only recommend what is best for you."
"You are probably right and I agree with you, but I still think you should go."
"It's not unusual to feel that way at first, but once you learn the routine, you'll be fine."
The Correct Answer is A
A. "Cardiac rehabilitation cannot undo the damage to your heart, but it can help you get back to your previous level of activity safely." This response is therapeutic and educative, helping the client understand that while damage cannot be reversed, rehabilitation supports safe recovery and improved quality of life.
B. "Your doctor is the expert here, and I'm sure he would only recommend what is best for you." This response does not address the client’s concerns and lacks supportive or educational value.
C. "You are probably right and I agree with you, but I still think you should go." This dismissive response fails to provide support, education, or empathy.
D. "It's not unusual to feel that way at first, but once you learn the routine, you'll be fine." Although this statement offers some support, it lacks the educational element needed to address the client’s concerns about the purpose of rehabilitation.
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Correct Answer is D
Explanation
A. Depression: While propranolol can sometimes worsen symptoms of depression, this is not as critical as the impact on conditions like heart failure.
B. Glaucoma: Propranolol does not typically affect glaucoma; however, some beta-blockers are used to treat glaucoma.
C. Migraine: Propranolol is sometimes used to prevent migraines, so a history of migraines would not require discontinuation.
D. Heart failure: Propranolol can exacerbate heart failure by reducing myocardial contractility. Clients with heart failure require careful monitoring or an alternative medication.
Correct Answer is B
Explanation
A. Suggest that the client rests before eating the meal. Although rest can help with nausea, it does not address the potential issue of digoxin toxicity, which can cause nausea.
B. Check the client's vital signs. Checking vital signs, especially heart rate, is the priority because nausea can indicate digoxin toxicity, which affects heart function.
C. Request a dietary consult. A dietary consult may be helpful if the client continues to refuse meals, but it does not address the immediate potential for digoxin toxicity.
D. Request an order for an antiemetic. Although an antiemetic may help with nausea, assessing for toxicity takes priority.