A newly admitted patient is having generalized anxiety, headache with pain level 4/10, and shortness of breath at rest. How should the nurse prioritize these problems?

headache with pain level 4/10

Generalized anxiety

Shortness of breath

Answer and Explanation

The Correct Answer is {"A":{"answers":"B"},"B":{"answers":"C"},"C":{"answers":"A"}}

Shortness of breath is a first-level priority because it is a potentially life-threatening issue. It requires immediate attention to ensure the patient is not experiencing an acute respiratory or cardiovascular event.

Headache with pain level 4/10 is a second-level priority because it is uncomfortable but not immediately life-threatening. The nurse should assess the cause of the headache, considering anxiety and other factors.

Generalized anxiety is a third-level priority as it does not pose an immediate threat to life, but should still be addressed to improve the patient’s comfort and well-being.

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Correct Answer is A

Explanation

A. This is the expected response when assessing accommodation. The pupils should constrict (become smaller) and the eyes should converge (move inward) as a person focuses on a near object.
B. This response is not typical for accommodation. Convergence should occur with pupil constriction when focusing on a near object.
C. Nystagmus (a rhythmic jerking of the eyes) is not a normal finding during accommodation testing. It could indicate neurological or vestibular issues.
D. This is not a typical accommodation response. The pupils should constrict, and the eyes should converge when focusing on a near object.

A. Achilles reflex, which is an expected response. B. Negative Babinski sign, which is normal for adults. C. Positive Babinski sign, which is abnormal for adults. D. Clonus, which is a hyperactive response

Correct Answer is C

Explanation

A. The Achilles reflex involves the contraction of the calf muscles, not the fanning of the toes.
B. A negative Babinski sign would show the toes curling downward, which is normal for adults, not fanning out.
C. A positive Babinski sign, where the toes fan out and the big toe dorsiflexes, is abnormal in adults and typically indicates neurologic damage or dysfunction.
D. Clonus involves repeated muscle contractions, not the fanning of the toes.

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A newly admitted patient is having generalized anxiety, headache with pain level 4/10, and shortness of breath at rest. How should the nurse prioritize these problems?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which of the following would be considered an expected finding when assessing accommodation in an adult client?

Correct Answer is A

Explanation

Correct Answer is C

Explanation

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