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 C
Explanation
A. Calcium 10 mg/dL: This calcium level is within the normal range (8.6-10.2 mg/dL) and does not require intervention.
B. Sodium 136 mEq/L: This sodium level is within the normal range (135-145 mEq/L).
C. Potassium 2.3 mEq/L: This potassium level is critically low; bumetanide is a loop diuretic that can cause hypokalemia, which can lead to dangerous cardiac dysrhythmias.
D. Magnesium 1.4 mEq/L: While slightly low, this magnesium level is only mildly decreased and not as immediately concerning as the potassium level.
Correct Answer is C
Explanation
A. Advise the client to come into the office. The client needs immediate emergency intervention, not a routine office visit.
B. Advise the client to take an antacid. Chest pain unrelieved by nitroglycerin may indicate myocardial infarction; an antacid would not help.
C. Instruct the client to call 911. Persistent chest pain unrelieved by nitroglycerin warrants emergency attention due to potential heart attack.
D. Tell the client to take another nitroglycerin tablet in 15 min. The protocol allows taking an additional dose in 5 minutes, but emergency services should be called for unrelieved chest pain.