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. A health care surrogate makes health care decisions when the client is no longer able: A health care surrogate, also called a health care proxy, is designated by the client to make medical decisions on their behalf if they become incapacitated.

B. Advance directives cannot be changed once implemented: Advance directives are legally binding but can be revised or revoked by the client at any time while they are competent. Flexibility allows clients to update their preferences as their health status or values change.

C. Assigning a health care surrogate requires legal consultation: While consulting an attorney can be helpful, it is not required to designate a health care surrogate. Most states allow clients to assign a surrogate using standardized forms provided by healthcare facilities or state agencies.

D. A client must create a do-not-resuscitate order when completing advance directives: Creating a DNR order is optional and only applicable if the client wishes to limit resuscitation. Advance directives encompass broader healthcare decisions beyond resuscitation preferences.

A. Obtain a prescription to refer the client to physical therapy. B. Instruct the client to wear sandals when ambulating. C. Encourage the client to dim the lights in hallways. D. Instruct the client to place throw rugs on bathroom floors.

Correct Answer is A

Explanation

Rationale:
A. Obtain a prescription to refer the client to physical therapy: A referral to physical therapy is appropriate because therapists can design individualized exercises to improve balance, coordination, and strength. This intervention promotes safe mobility, enhances independence, and reduces fall risk for clients with post-stroke weakness.

B. Instruct the client to wear sandals when ambulating: Sandals do not provide adequate foot support or traction and increase the risk of tripping or falling. Clients with right-sided weakness should wear well-fitting, non-skid shoes to ensure safety and stability during ambulation.

C. Encourage the client to dim the lights in hallways: Poor lighting impairs visibility and increases the risk of falls, especially for clients with weakness or gait instability. Adequate illumination in hallways and pathways is essential for safety during ambulation.

D. Instruct the client to place throw rugs on bathroom floors: Throw rugs are a major fall hazard due to their tendency to slip or bunch up. The nurse should advise removing rugs or securing them with non-slip backing to create a safe, stable walking environment.

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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?

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