A nurse is caring for a client who has pneumonia and tells the nurse, "I feel like an elephant is sitting on my chest." The client is weak and unable to walk.
After the nurse initiates chest pain protocol, which of the following is the priority diagnostic test?
12-lead ECG.
PT and INR.
Serum potassium.
Chest x-ray.
The Correct Answer is A
Choice A rationale:
A 12-lead ECG (electrocardiogram) is the priority diagnostic test for a patient with symptoms suggestive of chest pain and a potential cardiac event. Chest pain and a feeling of heaviness on the chest can be indicative of various cardiac conditions, including myocardial infarction (heart attack). A 12-lead ECG provides valuable information about the heart's electrical activity, helping healthcare providers assess for signs of ischemia, arrhythmias, or myocardial infarction. Early detection and intervention are crucial in cardiac emergencies, making
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Answer is: b. Document the client's condition every 15 min.
Explanation: The nurse manager should include the guideline to document the client's condition every 15 minutes while using belt restraints. This is to ensure close monitoring of the client's physical and psychological well-being and to evaluate the ongoing need for restraint use.
Choice a. is wrong because requesting a PRN restraint prescription for clients who are aggressive might not be appropriate. The use of restraints should be based on a thorough assessment of the client's condition and should be the least restrictive method possible.
Choice c. is wrong because attaching the restraint to the bed's side rails poses a safety risk to the client, as the side rails can be lowered accidentally or intentionally, leading to potential injury.
Choice d. is wrong because removing the client's restraint every 4 hours might not be appropriate, as it depends on the client's specific needs, facility policies, and state regulations. The nurse should follow appropriate guidelines for removing restraints and reassess the client's need for continued restraint use.
Correct Answer is ["A","D"]
No explanation
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