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
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
The correct answer is B.
Choice A reason: Avoid preparing medications for more than two clients at one time is a guideline aimed at reducing the risk of medication errors. However, it is not an absolute rule and may vary depending on the setting and resources available.
Choice B reason: Inform clients about the action of each medication prior to administration. This practice is essential for patient education, ensuring that patients are informed about what medications they are taking and why, which can improve adherence and outcomes.
Choice C reason: Reading medication labels at least two times prior to administration is a good practice to avoid errors, but it is not always specified as a standard requirement in medication administration guidelines.
Choice D reason: Completing an incident report if a client vomits after taking a medication is necessary only if the vomiting is related to an adverse drug reaction or a medication error, not for routine vomiting.
Correct Answer is B
Explanation
Choice A rationale:
Taking ibuprofen during pregnancy is generally not recommended, especially in high doses or for an extended period, as it can increase the risk of complications, including heart defects in the baby. Therefore, advising the client to take 600 milligrams of ibuprofen every 8 hours is not appropriate and potentially harmful during pregnancy.
Choice B rationale:
Having a cesarean birth (C-section) is recommended if there are visible lesions of genital herpes during labor and delivery. This precautionary measure helps prevent the transmission of the herpes simplex virus (HSV) from the mother to the baby, reducing the risk of neonatal herpes infection, which can be severe or even life-threatening.
Choice C rationale:
Testing the baby's cord blood for HSV is not a standard practice. Instead, if there are visible lesions or symptoms of herpes during labor, a C-section is often performed to minimize the risk of transmission. Testing the baby after birth may be done if there are concerns about potential exposure.
Choice D rationale:
Applying a cortisone cream to the lesions is not recommended without medical supervision during pregnancy. Topical corticosteroids, such as cortisone creams, can be absorbed through the skin and may have adverse effects on both the mother and the baby. It is essential to consult a healthcare provider before using any medications or creams during pregnancy to ensure safety for both the mother and the baby.
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