Nursing 166 NCLEX Qs

A nurse preparing to provide a client with Diphenhydramine (Benadryl) 25 mg orally would include which of the following statements in the teaching? 1- "Many people who take this medication report that is causes itchiing." 2- "Sometimes this medication can cause you to go to the bathroom more often than usual." 3- "This medication may make your mouth feel dry." 4- "This is a very low dose, so you may want to ask the doctor to increase it tomorrow."

3

A student nurse working with the charge nurse in a long term care facility asks, "How does all this get paid for?" The nurse would base his/her response on the knowledge that reimbursement for elder care began in the mid-1960s with the passage of what legislation? 1) The Omnibus Reconciliation Act 2) The Americans with Disabilities Act 3) Title XVII & XXIX Medicare & Medicaid 4) The Social Security Act

3

A nurse is working with patients in a long term care setting. Which of the following patients is at the highest risk for falling? 1- A patient with heart failure who requires a 2-person assist for wheelchair transfers. 2- A patient that ambulates well with a walker and gets up to void several times at night. 3- A patient's who is blind and has two side-rails up while in bed. 4- A patient with Parkinson's disease that holds onto furniture while ambulating in their room.

4

A nurse is caring for an 86 year old female recently admitted to the skilled care facility after a left hip fracture with repair. During report the nurse learns the client is weak on the left side and has a slightly unsteady gait and uses a walker for ambulation. Which action by the nurse would best help prevent complications? 1- Use a Hoyer lift for all transfers. 2- Ensure participation in physical therapy and rehab activities. 3- Assess the client's gait and transfer ability every two hours. 4- Encourage the client to choose foods rich in carbohydrate.

2

The charge nurse is preparing to make resident-care assignments on a skilled nursing unit. In order to complete this task, which of the following should the nurse do first? 1) Compile a list of planned baths and dressing changes for clients throughout the day. 2) Obtain shift report from the out-going charge nurse and determine patient acuity and care needs. 3) Identify which staff members were present the day before and what their assignments were. 4) Complete an accurate on-coming count of all narcotic medications.

2

What do the Centers for Medicare and Medicaid outline as an appropriate goal for the resident's medication regimen? 1) Non-pharmacological interventions should replace prescribed medications. 2) Maintain the resident's highest practical, mental, physical, and psychological well-being. 3) Medication reviews completed quarterly by randomly selected physicians. 4) Increase the number of prescribed generic medications to decrease cost.

2

A major concept underlying the process of Root Cause Analysis is that a majority of medical errors: 1- are related to increased technology and lack of sufficient training 2- result from individual human error 3- are caused by a faulty system or process 4- result from short staffing and time constraints

3

An 89 year old with advanced dementia is notably short of breath, appears flushed, and is coughing during Bingo at the local long term care facility. The respiration rate is 30/min and pulse is 115 bpm. Arrange the nursing actions in order of priority with the highest priority listed first. 1- obtain the patient's blood pressure and temperature. 2- Identify the client's code status and treatment wishes in the chart. 3- Notify the ordering health care practitioner to request admission to an acute care setting. 4- Provide 2L oxygen via nasal cannula.

4-1-2-3

A new nurse at the long term care facilty is interested in using the PAIN AD scale on the dementia unit. To effectively use the scale, which action should the nurse take first? 1- Identify each client's history for a diagnosis of arthritis. 2- Examine the client's medication record for prescribed pain meds. 3- Ask the client's roommate if the client has been moaning in his sleep. 4- Observe clients in their resting state for indications of pain first.

4

The nurse is assessing an 80-year-old resident who has sustained a fractured hip as a result of a fall. Which data should be reported to the health care provider immediately? 1) pain at the site of the fracture with movement of the extremity. 2) Localized bruising occurring hours after the injury. 3) Client reports a need to move his bowels. 4) Delayed capillary refill in the toes of the affected extremity.

4

When a patient exhibits signs and symptoms of delirium, which of the following actions should the nurse take first? 1) Determine if the client has an anti-anxiety medication ordered 2) Check the client's temperature 3) Identify when the client's labs were drawn most recently 4) Take the client's pulse oximeter reading

4

Which of the following interventions should be taken to help an older client to prevent osteoporosis? A. Decrease dietary calcium intake. B. Increase sedentary lifestyles C. Increase dietary protein intake. D. Encourage regular exercise.

D. Encourage regular exercise. Rationale: Key word in question is prevent Weight-bearing exercises helps to fight off degeneration of bone in osteoporosis

Which of the following statements accurately reflects data that the nurse should use in planning care to meet the needs of the older adult? A. 50% of older adults have two chronic health problems. B. Cancer is the most common cause of death among older adults. C. Nutritional needs for both younger and older adults are essentially the same. D. Adults older than 65 years of age are the greatest users of prescription medications.

D. Adults older than 65 years of age are the greatest users of prescription medications. Rationale: Approximately two thirds of older adults use prescription and nonprescription drugs with one third of all prescriptions being written for older adults

A client diagnosed with pneumonia recently returned to an assisted living facility after being treated in the hospital with IV antibiotics. The client begins having consistent foul smelling diarrhea and is diagnosed with clostridium difficile. Which statement by the client indicates further teaching is necessary? 1- "I need to wash my hands once a day." 2- "I need to drink at least six glasses of water a day." 3- "clostridium difficile is highly contagious." 4- "Care providers will wear protective clothing in my room."

1

An 88 year old client mentions to the nurse, that he does like to drink to much water, to avoid using the bathroom frequently. Which clinical manifestations would be most concerning to the nurse? 1- Prolonged tenting to the skin at the clavicle 2- 300 mL clear yellow urine in the urinal 3- Mucous membranes appear moist, shiny and pink 4- Blood glucose is 89 before breakfast

1

1. The nurse is performing an assessment on an older client who is having difficulty sleeping at night. Which statement by the client indicates the need for further teaching regarding measures to improve sleep? a) "I swim three times a week." b) "I have stopped smoking cigars." c) "I drink hot chocolate before bedtime." d) "I read for 40 minutes before bedtime."

1) C - Rationale: Many nonpharmacological sleep aids can be used to influence sleep. However, the client should avoid caffeinated beverages and stimulants such as tea, cola, and chocolate. The client should exercise regularly, because exercise promotes sleep by burning off tension that accumulates during the day. A 20-to 30-minute walk, swim, or bicycle ride three times a week is helpful. The client should sleep on a bed with a firm mattress. Smoking and alcohol should be avoided. The client should avoid large meals; peanuts, beans, fruit, raw vegetables, and other foods that produce gas; and snacks that are high in fat because they are difficult to digest. - Test-Taking Strategy: Note the strategic words need for further teaching . These words indicate a negative event query and ask you to select an option that is an incorrect statement. Options A, B, and D are positive statements indicating that the client understands the methods of improving sleep.

The RN is preparing to receive a new admission on the sub-acute rehab unit. Identify the appropriate delegation of tasks. (Select all that apply.) 1- A CNA is asked to place equipment and client supplies in the room. 2- The social worker is asked to arrange diet orders and meal planning. 3- The RN plans to perform an initial assessment. 4- A CNA is asked to change the client's wound dressing upon arrival. 5- An LPN is informed he/she will be assigned to provide oral medications for the client.

1-3-5

A paraplegic patient, paralyzed from the waist down, is newly diagnosed with a stage II pressure ulcer on the left hip. In planning care for this patient the nurse would include which of the following interventions? (Select all that apply) 1- Encourage a high protein diet 2- Turn the patient every 6 hours 3- Use hot water and maximize soap for bathing needs 4- Limit the number of linens between the patient and mattress 5- Provide a trapeze over the patient's bed to allow self-repositioning

1-4-5

2. Geriatric Nursing Exam Questions about a visiting nurse who observes that the older male client is confined by his daughter-in-law to his room. When the nurse suggests that he walk to the den and join the family, he says, "I'm in everyone's way; my daughter-in-law needs me to stay here." Which is the most important action for the nurse to take? a) Say to the daughter-in-law, "Confining your father-in-law to his room is inhumane." b) Suggest to the client and daughter-in-law that they consider a nursing home for the client. c) Say nothing, because it is best for the nurse to remain neutral and wait to be asked for help. d) Suggest appropriate resources to the client and daughter-in-law, such as respite care and a senior citizens' center.

2) D - Geriatric Nursing Exam Questions Rationale: Assisting clients and families to become aware of available community support systems is a role and responsibility of the nurse. Observing that the client has begun to be confined to his room makes it necessary for the nurse to intervene legally and ethically, so option C is not appropriate and is passive in terms of advocacy. Option B suggests committing the client to a nursing home and is a premature action on the nurse's part. Although the data provided tell the nurse that this client requires nursing care, the nurse does not know the extent of the nursing care required. Option A is incorrect and judgmental. - Test-Taking Strategy: Note the strategic words most important. Using principles related to the ethical and legal responsibility of the nurse and knowledge of the nurse's role will direct you to the correct option. Option A is a nontherapeutic statement, option B is a premature action, and option C avoids the situation.

A new nurse is being oriented as an LPN to a sub acute rehabilitation facility. The nurse recognizes that physician care in a nursing home is based on which of the following statements? 1) Nursing home residents today require fewer visits by physicians. 2) Federal law mandates that physicians visit their patients on a bi-annual basis. 3) Physician services are required to be available as needed 7 days a week, 24 hours a day. 4) Physicians are required to respond to the medical needs of residents within 1 week of notification.

3

A nurse is taking care an 81 year old male who recently experienced a cerebrovascaular accident (CVA) that damaged the temporal lobe of the brain. The nurse would expect this patient to need assistance with which of the following? 1- Reasoning 2- Temperature Regulation 3- Communication 4- Coordination

3

A patient is newly diagnosed with iron-deficiency anemia. Which of the following meal selections indicates the patient understands important dietary modifications? 1- A hot dog, cole slaw and apple 2- A pork chop, garden salad and apple pie 3- Liver and onions, broccoli, and raisin pudding 4- Chef salad with kale, bran muffin and jello

3

An LPN is working on a continuous quality improvement project within a nursing home to examine preventable hospitalizations. Which of the following would serve as the best motivation for this project? 1) Long-term care physicians are poorly prepared to intervene in acute care scenarios. 2) Reducing transfers to the hospital will cut down on administrative paperwork for the facility. 3) A transfer in and out of the nursing home exposes the resident to additional risk and increased morbidity. 4) Reducing potentially avoidable hospitalizations increases healthcare expenses.

3

Nursing practice and the profession as a whole is legally directed by which of the following? 1) The National Council Licensure Examination 2) Joint Commission of Accreditation for Healthcare Organizations. 3) Laws developed by each state's board of nursing. 4) Federal regulations.

3

The RN in a long-term care facility begins an admission assessment on an 96 year old male with a history of pneumonia who is oriented to person only. Family members state that he is normally fully oriented. What action should the nurse take first? 1- Check his blood pressure 2- Check his blood sugar 3- Check his oxygen saturation 4- Check his pupils

3

The nurse is provided teaching for a client who was recently diagnosed with CHF. Which of the following comments, made by the patient, indicates the need for further teaching? 1- "If I suddenly start coughing up foamy, pink mucous I should contact a doctor right away" 2- "If my heart failure gets worse I could feel short of breath even at rest" 3- "If I notice a weight gain of more than 5 pounds in a day I should not be concerned, this is to be expected." 4- "I could feel weak or dizzy so need to make sure to get up slowly in order to avoid passing out."

3

3. The nurse is performing an assessment on an older adult client. Which assessment data would indicate a potential complication associated with the skin? a) Crusting b) Wrinkling c) Deepening of expression lines d) Thinning and loss of elasticity in the skin

3) A - Rationale: The normal physiological changes that occur in the skin of older adults include thinning of the skin, loss of elasticity, deepening of expression lines, and wrinkling. Crusting noted on the skin would indicate a potential complication. - Geriatric Nursing Exam Questions Test-Taking Strategy: Note the subject , a potential complication. Think about the normal physiological changes that occur in the aging process to direct you to the correct option.

What action(s) by the nurse can help to decrease the associated length of hospital stay, costs and cognitive effects for a patient experiencing delirium? Select all that apply 1) Placing the patient in physical restraints. 2)Use antipsychotic medication immediately to restrain client activity. 3) Early treatment of the underlying cause. 4) Keep the client in bed at all times to reduce the risk of falls. 5) Recognition of the change in mental status.

3-5

A 72 year old client is admitted to a long term care facility with impaired mobility and poor nutritional status after a CVA. Which of the following is an appropriate action for the LPN assigned to his care? 1- Perform an initial skin assessment 2- Delegate routine skin care to the nursing assistant. 3- Massage redenned areas noted on the client's bony prominences. 4- Assist the RN to develop a q2 hour turning schedule.

4

When reviewing the care provided in a long term care facility, which of the following would be considered negligent? 1) A summary of medical needs of the resident were included in the hospital's transfer documents. 2) The resident's dietary preferences were incorporated into meal planning and preparation. 3) A comprehensive plan of care was developed by a multidisciplinary team. 4) Each member of the health care team completed their portion of the MDS within 30 days of admission.

4

Which of the following patients would have the highest risk of developing a lower respiratory infection? 1- A 78-year-old with a BMI of 29 who has a history of diabetes mellitus. 2- A 77-year-old who recently received the pneumonia vaccine. 3- An 84-year-old who lives independently and exercises daily. 4- An 81-year-old recently transferred to a long term care facility after hospitalization for a fractured tibia.

4

4. The home health nurse is visiting a client for the first time. While assessing the client's medication history, it is noted that there are 19 prescriptions and several over-the-counter medications that the client has been taking. Which intervention should the nurse take first? a) Check for medication interactions. b) Determine whether there are medication duplications. c) Call the prescribing health care provider (HCP) and report polypharmacy. d) Determine whether a family member supervises medication administration.

4) B - Rationale: Polypharmacy is a concern in the older client. Duplication of medications needs to be identified before medication interactions can be determined because the nurse needs to know what the client is taking. Asking about medication administration supervision may be part of the assessment but is not a first action. The phone call to the HCP is the intervention after all other information has been collected. - Test-Taking Strategy: Note the strategic word first . Also note that the nurse is visiting the client for the first time. Options A, C, and D should be done after possible medication duplication has been identified.

5. The long-term care nurse is performing assessments on several of the residents. Which are normal age-related physiological change(s) the nurse expects to note? Select all that apply. a) Increased heart rate b) Decline in visual acuity c) Decreased respiratory rate d) Decline in long-term memory e) Increased susceptibility to urinary tract infections f) Increased incidence of awakening after sleep onset

5) B, E, F - Geriatric Nursing Exam Questions Rationale: Anatomical changes to the eye affect the individual's visual ability, leading to potential problems with activities of daily living. Light adaptation and visual fields are reduced. Although lung function may decrease, the respiratory rate usually remains unchanged. Heart rate decreases and heart valves thicken. Age-related changes that affect the urinary tract increase an older client's susceptibility to urinary tract infections. Short-term memory may decline with age, but long-term memory usually is maintained. Change in sleep patterns is a consistent, age-related change. Older persons experience an increased incidence of awakening after sleep onset. - Test-Taking Strategy: Focus on the subject , normal age-related changes. Read each characteristic carefully and think about the physiological changes that occur with aging to select the correct items.

When making client assignments to the unlicensed assistive personnel, the practical nurse should use the standard of "right communication" related to the assigned task. Which statement best meets this standard? 1. "I need for you to take vital signs on all clients in rooms 1-10 this morning." 2. "Mr. Wu's blood pressure has been low. Please take his vital signs first and let me know if his systolic blood pressure is <100" 3. "Mrs. Jones fell out of bed during the night. Be sure you keep a close eye on her this shift." 4. "Would you please make sure Mr. Garcia in bed 8 ambulates several times?"

ANS 2 In the joint statement on delegation (2007), the American Nurses Association and the National Council of State Boards of Nursing outline the 5 Rights of Delegation as seen above (Table). The practical nurse (PN) needs to direct the actions of unlicensed assistive personnel (UAP) and communicate clearly about the assigned tasks, including any specific information necessary for completion (eg, methods for collection, time frame, when to report back to the PN). Option 2 gives UAP directions with prioritization and specific instructions for reporting back findings. (Option 1) The time frame in this option should be more specific. In addition, there is no communication about what the PN expects as follow-up. (Option 3) The instruction to "keep a close eye" on the client leaves UAP too much room for interpretation. The expectation from the PN is not clear, and UAP need more direction. (Option 4) The instructions are too broad and don't give a specific time frame. The PN should also communicate the method needed to accomplish the task

The nurse on the orthopedic unit receives information during evening report. Which client should the nurse see first? 1. Client 3 hours postoperative tibial fracture repair who reports severe pain and pressure under the cast and is requesting opioids every hour 2. Client 6 hours postoperative rotator cuff repair with a sling immobilizer who has moderate swelling and tingling of the hand and fingers 3. Client 8 hours postoperative total knee arthroplasty who has 2 closed-wound suction drains and a total output of 200 mL sanguineous drainage 4. Male client 1 day postoperative total hip replacement prescribed enoxaparin who has a hematocrit of 37% (0.37) and hemoglobin of 12.5 g/dL (125 g/L)

Ans 1 Compartment syndrome results from swelling and increased pressure within a confined space (a compartment). It is most common with lower extremity injuries but can also occur in the arm. Pressure from bleeding/edema can exceed capillary perfusion pressure and lead to decreased perfusion and tissue ischemia below the site of increased pressure. Early manifestations include increasing pain unrelieved by opioids or elevation, pain with passive motion, pallor, and paresthesia due to nerve compression and ischemia. If the pressure is not relieved within 4-6 hours of onset (eg, surgical fasciotomy, cast removal), irreversible nerve and muscle injury can occur. (Option 2) Immobilization of the extremity in a sling can lead to venous pooling and edema of the hands and fingers if the sling is not applied properly. The nurse should evaluate the elbow and hand positions and perform a neurovascular assessment, but this is not the priority. (Option 3) Sanguineous (red) wound drainage at 25 mL/hr is expected 1 day postoperative knee replacement. Drains are usually removed in 24 hours unless drainage is excessive (eg, >1500 mL/24 hr). (Option 4) Anticoagulant therapy (eg, unfractionated heparin, enoxaparin, fondaparinux) is standard following total hip replacement. Slightly decreased hematocrit and hemoglobin levels (normal male: 39%-50% [0.39-.50], 13.2-17.3 g/dL [132-173 g/L], respectively) are expected due to intra- and postoperative blood loss. Educational objective: Compartment syndrome is a medical emergency that requires decompression within 4-6 hours of onset (eg, fasciotomy, cast removal) to prevent irreversible nerve and muscle injury.l

The unlicensed assistive personnel notifies the charge nurse that the client is reporting feeling short of breath. What should the charge nurse do first? 1. Activate a rapid response team 2. Ask the unlicensed assistive personnel to take vital signs and report back 3. Direct the client's primary nurse to examine the client 4. Personally go and auscultate the client's lungs

Ans 4 When a nurse receives report from unlicensed assistive personnel (UAP) of a client symptom that is potentially ominous, the nurse should personally assess the client. This is the primary nursing assessment that will be used to decide if an urgent need exists that requires intervention. (Option 1) It is important for the charge nurse to personally assess the client prior to initiating a rapid response team based on a report from the UAP without the appropriate knowledge and skills. The nurse may not find an acute client need during the assessment. (Option 2) UAP could be asked to accompany the nurse and obtain vital signs as the nurse is assessing the client, but UAP should not be asked to independently obtain this assessment first. (Option 3) The charge nurse should assess the client personally rather than assign the task to the client's primary nurse. Shortness of breath is a priority symptom (airway, breathing), and delegating this assessment could cause a delay in care. The charge nurse or a registered nurse should be involved when there is a new-onset change in a client's condition that might indicate a developing instability

When administering tetracycline (Achromycin) to a client with PUD, the nurse should do which of the following?SATA a) Give with full glass of water on an empty stomach. b) Give at least 1 hr before a meal. c) Keep in a dry place. d) Administer with milk or milk products. e) Protect from light.

Answer: a, b, c, e Oral tetracycline (Achromycin) is administered with a full glass of water on an empty stomach at least 1 hr before or 2 hr after meals (food, milk, and milk products can reduce absorption by 50% or more). The nurse does not administer the drug immediately before bed, or with foods high in calcium such as milk or milk products. Tetracycline (Achromycin) decomposes with age, exposure to light, and when stored incorrectly. Correct storage involves a tightly sealed container stored in a dry place protected from light, with a temperature of 59° to 86°F.

In performing a physical assessment for an older adult, the nurse anticipates finding which of the following normal physiological changes of aging? A. Increased perspiration B. Increased airway resistance C. Increased salivary secretions D. Increased pitch discrimination

B. Increased airway resistance Rational: Normal physiological changes of aging include increased airway resistance in the older adult. The older adult would be expected to have decreased perspiration and drier skin as they experience glandular atrophy (oil, moisture, sweat glands) in the integumentary system. The older adult would be expected to have a decrease in saliva. A normal physiological change of the older adult related to hearing is a loss of acuity for high-frequency tones (presbycusis).

A long-term care facility sponsors a discussion group on the administration of medications. The participants have a number of questions concerning their medications. The nurse responds most appropriately by saying: A. "Don't worry about the medication's name if you can identify it by its color and shape." B. "Unless you have severe side affects, don't worry about the minor changes in the way you feel." C. "Feel free to ask your physician why you are receiving the medications that are prescribed for you." D. "Remember that the hepatic system is primarily responsible for the pharmacotherapeutics of your medications."

C. "Feel free to ask your physician why you are receiving the medications that are prescribed for you." Rationale: The nurse should encourage the older adult to question the physician and/or pharmacist about all prescribed drugs and over-the-counter drugs. The older adult should be taught the names of all drugs being taken, when and how to take them, and the desirable and undesirable effects of the drugs.

In reviewing changes in the older adult, the nurse recognizes that which of the following statements related to cognitive functioning in the older client is true? A. Delirium is usually easily distinguished from irreversible dementia. B. Therapeutic drug intoxication is a common cause of senile dementia. C. Reversible systemic disorders are often implicated as a cause of delirium. D. Cognitive deterioration is an inevitable outcome of the human aging process.

C. Reversible systemic disorders are often implicated as a cause of delirium. Rationale: Delirium is a potentially reversible cognitive impairment that is often due to a physiological cause such as an electrolyte imbalance, cerebral anoxia, hypoglycemia, medications, tumors, cerebrovascular infection, or hemorrhage.

When developing the plan of care for an older adult who is hospitalized for an acute illness, the nurse should A. use a standardized geriatric nursing care plan. B. plan for likely long-term-care transfer to allow additional time for recovery. C. consider the preadmission functional abilities when setting patient goals. D. minimize activity level during hospitalization.

C. consider the preadmission functional abilities when setting patient goals. Rationale: The plan of care for older adults should be individualized and based on the patients current functional abilities. A standardized geriatric nursing care plan is unlikely to address individual patient needs and strengths. A patients need for discharge to a long-term-care facility is variable. Activity level should be designed to allow the patient to retain functional abilities while hospitalized and also to allow any additional rest needed for recovery from the acute process.

The nurse is setting up an education session with an 85-year-old patient who will be going home on anticoagulant therapy. Which strategy would reflect consideration of aging changes that may exist with this patient? A. Show a colorful video about anticoagulation therapy. B. Present all the information in one session just before discharge. C. Give the patient pamphlets about the medications to read at home. D. Develop large-print handouts that reflect the verbal information presented.

D. Develop large-print handouts that reflect the verbal information presented. Rationale: Option D addresses altered perception in two ways. First, by using visual aids to reinforce verbal instructions, one addresses the possibility of decreased ability to hear high-frequency sounds. By developing the handouts in large print, one addresses the possibility of decreased visual acuity. Option A does not allow discussion of the information; furthermore, the text and print may be small and difficult to read and understand.

A home health nurse visits a client 2 weeks after discharge from the hospital. The client experienced an acute myocardial infarction and subsequent heart failure. Home medications are listed in the exhibit. Which symptom reported by the client is most concerning to the nurse? Click on the exhibit button for additional information. 1. Bruising easily, especially on arms 2. Fatigue 3. Feeling depressed 4. Muscle cramps in legs

The nurse would be most concerned with the client's report of muscle cramps in the legs. This could be a sign of hypokalemia caused by use of the diuretic furosemide or possibly a reaction from the statin medication atorvastatin. Hypokalemia may manifest as muscle cramps, weakness, or paralysis and typically starts with the leg muscles. Hypokalemia could be dangerous in this client due to possible arrhythmias in the presence of existing cardiac dysfunction. The client may need to be started on supplemental potassium and a high-potassium diet if the serum potassium level is low. If the potassium level is normal, atorvastatin may be responsible for muscle cramps. (Option 1) Bruising, especially on the upper extremities, is common with the use of antiplatelet agents such as aspirin and clopidogrel. The nurse should teach the client to monitor for other, more severe signs of bleeding, such as blood in the stool. (Option 2) The myocardial infarction and heart failure have most likely reduced the client's functional capacity and can cause fatigue. Beta blockers such as metoprolol can also cause fatigue. This will improve with time, and the nurse should talk to the client about possible cardiac rehabilitation. (Option 3) Feeling depressed is common after an acute health-related event such as a myocardial infarction. The client needs to be evaluated further and may need an antidepressant. However, feelings of depression are not immediately life-threatening unless the client exhibits suicidal ideation. Educational objective: The nurse should recognize muscle cramps in the legs as a possible sign of hypokalemia in the client taking diuretics. Muscle cramps should be reported to the health care provider in anticipation of checking a potassium level, adding a potassium supplement, and instructing the client to eat potassium-rich foods.