A client is in the emergency room in critical condition and hypotensive. Her spouse is distraught. What is the priority nursing action?
Call a chaplain
Maintain the client’s blood pressure
Provide the spouse a chair
Ask the client’s spouse to explain what happened
The Correct Answer is B
Choice A reason: Calling a chaplain is not the priority nursing action for a client who is in critical condition and hypotensive. The chaplain may not be available or may not be able to provide adequate support to the spouse. This choice does not address the client’s urgent medical needs or the spouse’s emotional needs.
Choice B reason: Maintaining the client’s blood pressure is the priority nursing action for a client who is in critical condition and hypotensive. The nurse should monitor the client’s vital signs, administer fluids and medications, and provide oxygen as ordered. This choice addresses the client’s urgent medical needs and may prevent further complications.
Choice C reason: Providing the spouse a chair is not the priority nursing action for a client who is in critical condition and hypotensive. The spouse may not want to sit down or may not be able to stay calm. This choice does not address the client’s urgent medical needs or the spouse’s emotional needs.
Choice D reason: Asking the client’s spouse to explain what happened is not the priority nursing action for a client who is in critical condition and hypotensive. The spouse may not be able to recall or communicate the details of the event. This choice does not address the client’s urgent medical needs or the spouse’s emotional needs.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C","E"]
Explanation
Choice A reason: Candidiasis is an opportunistic infection associated with AIDS. Candidiasis is a fungal infection caused by Candida species, which normally live in the mouth, throat, vagina, and intestines. In people with AIDS, the immune system is weakened and cannot control the growth of Candida, leading to oral thrush, esophagitis, vaginitis, or systemic candidiasis.
Choice B reason: Hodgkin's lymphoma is not an opportunistic infection associated with AIDS. Hodgkin's lymphoma is a type of cancer that affects the lymphatic system, which is part of the immune system. It is characterized by the presence of ReedSternberg cells, which are abnormal lymphocytes. The exact cause of Hodgkin's lymphoma is unknown, but it is not related to any specific infection.
Choice C reason: Pneumocystis jiroveci pneumonia is an opportunistic infection associated with AIDS. Pneumocystis jiroveci pneumonia is a fungal infection caused by Pneumocystis jiroveci, which normally lives in the lungs of healthy people without causing any symptoms. In people with AIDS, the immune system is weakened and cannot prevent the invasion of Pneumocystis jiroveci, leading to pneumonia, which is a serious and potentially fatal lung infection.
Choice D reason: Clostridium difficile is not an opportunistic infection associated with AIDS. Clostridium difficile is a bacterial infection caused by Clostridium difficile, which normally lives in the colon of healthy people without causing any problems. In some cases, the use of antibiotics can disrupt the normal balance of bacteria in the colon and allow Clostridium difficile to overgrow and produce toxins, leading to diarrhea, colitis, or pseudomembranous colitis. This infection can affect anyone, regardless of their HIV status.
Choice E reason: NonHodgkin's lymphoma is an opportunistic infection associated with AIDS. NonHodgkin's lymphoma is a type of cancer that affects the lymphatic system, which is part of the immune system. It is characterized by the presence of abnormal lymphocytes, which may be B cells, T cells, or natural killer cells. NonHodgkin's lymphoma is associated with several infections, such as EpsteinBarr virus, human herpesvirus 8, hepatitis C virus, and human Tcell leukemia virus, which may trigger the transformation of lymphocytes in people with AIDS.
Correct Answer is A
Explanation
Choice A reason: Alcohol can trigger a gout attack because it increases the production and decreases the excretion of uric acid, which is the substance that causes inflammation and pain in the joints. Alcohol also dehydrates the body, which can worsen the symptoms of gout.
Choice B reason: Fruit juice is not a beverage that can trigger a gout attack. Fruit juice contains natural sugars and antioxidants, which may have a beneficial effect on the uric acid levels and the inflammation in the body. However, fruit juice should be consumed in moderation, as excess sugar intake can lead to weight gain and other health problems.
Choice C reason: Milk is not a beverage that can trigger a gout attack. Milk contains protein and calcium, which may help lower the uric acid levels and the risk of gout. Milk also has antiinflammatory properties, which may reduce the pain and swelling in the joints.
Choice D reason: Coffee is not a beverage that can trigger a gout attack. Coffee contains caffeine and antioxidants, which may have a protective effect on the uric acid levels and the inflammation in the body. Coffee also has a diuretic effect, which may help flush out the excess uric acid from the kidneys.
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