A nurse is assessing a client's pulmonary artery wedge pressure (PAWP). The nurse should recognize that an elevated PAWP indicates which of the following complications?

Hypovolemia

Hypotension

Left ventricular failure

Cardiogenic shock

Answer and Explanation

The Correct Answer is C

Rationale:
A. Hypovolemia: Hypovolemia causes a decrease in PAWP due to reduced circulating blood volume and inadequate venous return to the heart. A low PAWP reflects decreased left ventricular preload, not an elevated value.

B. Hypotension: Hypotension alone does not directly increase PAWP. In fact, low blood pressure often accompanies decreased cardiac filling pressures. Elevated PAWP typically occurs with fluid overload or impaired ventricular function rather than simple hypotension.

C. Left ventricular failure: An elevated PAWP indicates increased left-sided heart pressures due to ineffective left ventricular pumping. Blood backs up into the pulmonary circulation, leading to pulmonary congestion and edema.

D. Cardiogenic shock: In cardiogenic shock, PAWP can be elevated due to impaired contractility, but it is accompanied by low cardiac output and hypotension. While related, the elevated PAWP in cardiogenic shock results from the underlying left ventricular failure, which is the primary cause of the pressure increase.

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Correct Answer is A

Explanation

Rationale:
A. Encourage cultural practices to be incorporated into their care: Respecting and incorporating a Muslim client’s cultural and religious practices promotes culturally competent and patient-centered care. This approach fosters trust, comfort, and cooperation between the client and healthcare team.

B. Incorporate hot and cold practices into the client's care: Hot and cold theory is typically associated with Hispanic, Asian, and Middle Eastern folk medicine traditions, but not all Muslim clients follow this practice. Care should be based on the client’s individual beliefs.

C. Acknowledge that the client may be cared for by a male provider: Many Muslim women prefer to be cared for by female providers due to religious and cultural values of modesty. The nurse should make reasonable efforts to accommodate this preference whenever possible.

D. Have the client remove any face coverings to obtain their history: Muslim women who wear a niqab or hijab may choose to keep their face covered for modesty. The nurse should not insist on removal unless necessary for identification or assessment, and even then, it should be done privately with sensitivity to religious beliefs.

A. Sunken fontanels and dry mucous membranes B. Temperature 38° C (100.4° F) and pulse rate 124/min C. Pale and a 24-hr fluid deficit of 30 mL D. Decreased appetite and irritability

Correct Answer is A

Explanation

Rationale:
A. Sunken fontanels and dry mucous membranes: These findings indicate moderate to severe dehydration, which can quickly become life-threatening in an infant. Prompt notification of the provider is essential to initiate fluid replacement and prevent complications such as hypovolemic shock.

B. Temperature 38° C (100.4° F) and pulse rate 124/min: A low-grade fever and mildly elevated pulse are common in gastroenteritis and typically do not require immediate reporting unless accompanied by other concerning symptoms like poor perfusion or lethargy.

C. Pale and a 24-hr fluid deficit of 30 mL: A fluid deficit of 30 mL over 24 hours is minimal in an infant and not immediately concerning. Monitoring should continue, but urgent reporting is not necessary for this level of deficit.

D. Decreased appetite and irritability: These are expected symptoms of gastroenteritis in infants and can be managed with routine supportive care and monitoring. They are not specific indicators of severe dehydration requiring immediate provider intervention.

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