A client with a recent ST segment elevation MI (STEMI) presents with bilateral lower extremity edema and crackles throughout the lung fields.What is the nurse's priority intervention for this client?
Increase the client's fluid intake to prevent dehydration.
Administer prescribed diuretics to reduce fluid overload.
Apply warm compresses to the lower extremities to reduce edema.
Encourage the client to ambulate to improve circulation.
The Correct Answer is B
Choice A rationale
Increasing fluid intake is contraindicated in clients with fluid overload, such as those with bilateral lower extremity edema and lung crackles. It can worsen the condition.
Choice B rationale
Administering prescribed diuretics is the priority intervention to reduce fluid overload in clients with heart failure post-STEMI. It helps to decrease edema and pulmonary congestion.
Choice C rationale
Applying warm compresses to the lower extremities may provide temporary relief but does not address the underlying issue of fluid overload.
Choice D rationale
Encouraging ambulation is beneficial for overall health but is not a priority intervention for managing fluid overload in this context. .
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Blood glucose levels are important but are not the immediate priority for assessing the cause of severe vomiting and diarrhea with lightheadedness. Electrolyte imbalances are more likely to be the cause.
Choice B rationale
Serum potassium levels should be prioritized as vomiting and diarrhea can lead to significant potassium loss, which can result in dangerous cardiac and neuromuscular symptoms. Assessing potassium levels is crucial in this scenario.
Choice C rationale
Lipid profile is not relevant in the acute assessment of severe vomiting, diarrhea, and lightheadedness. This test is more useful for long-term cardiovascular risk assessment.
Choice D rationale
Thyroid function tests are not immediately relevant to the acute symptoms of vomiting and diarrhea with lightheadedness. Electrolyte imbalances are a more immediate concern.
Correct Answer is B
Explanation
Choice A rationale
While swimming can be less likely to trigger asthma attacks than some other sports, children with asthma should not necessarily stop playing basketball if it's something they enjoy. Proper management and understanding triggers are crucial.
Choice B rationale
Avoiding triggers that cause an asthma attack is a fundamental part of asthma management. Triggers can vary from person to person and may include allergens, smoke, cold air, and exercise.
Choice C rationale
The peak expiratory flow meter should be used regularly, typically twice a day, to monitor asthma control, not just once per week. Regular use helps identify worsening symptoms early.
Choice D rationale
Cromolyn sodium is a preventive medication and should be taken regularly as prescribed, not just at the first sign of breathing difficulty.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.