A nurse is assisting with the care of a client in an outpatient provider's office.
The nurse should identify that the client is at risk of developing
The Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"A"}
The nurse should identify that the client is at risk of developing heart failure and may require further assessment and intervention.
Heart failure is suggested by the progressive decline in vital signs and laboratory results, such as increasing BUN and creatinine levels, which indicate worsening kidney function and can contribute to heart failure. The client’s fatigue, weakness, bilateral edema, and crackles in the lungs are clinical signs consistent with heart failure. The dry, flaky skin and coarse, thinning hair also reflect systemic issues that could be associated with heart failure and poor nutritional status.
The nurse should focus on further assessment to evaluate the severity of heart failure and intervention to manage symptoms, potentially including medication adjustments, fluid management, and additional diagnostic testing. These steps are crucial to addressing the client’s deteriorating condition and preventing further complications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Allowing a family member to stay with the body is a common practice in many cultures, but it is not specific to Islamic practices.
B. Positioning the head northward is not a specific requirement of Islamic postmortem care.
C. Correct. Positioning the client's head toward Mecca is an important aspect of Islamic postmortem care, as Muslims pray facing Mecca.
D. Allowing a family member to stay with the body for a specific duration is not a specific Islamic practice.
Correct Answer is D
Explanation
A. Incorrect. Assisting the client with relaxation techniques can be helpful in managing bladder training, but determining the client's voiding pattern is the first step in designing an effective program.
B. Incorrect. Discouraging the intake of carbonated beverages might be part of the bladder training plan, but the first step is to assess the client's current voiding pattern.
C. Incorrect. Offering toileting opportunities every 1 to 2 hours is part of the bladder training program, but determining the client's voiding pattern is the initial action.
D. Correct. The nurse should first determine the client's pattern for voiding, including the frequency of voiding and any patterns of urgency or incontinence. This information is essential to tailor the bladder training program to the client's individual needs.
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