A nurse is caring for a patient who reports fatigue and had a syncopal episode at home.
The nurse has completed an assessment on the client after the syncopal episode. Complete the following sentence by using the list of options.
The nurse should first address the patient’s
The Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"A"}
Answer: The nurse should first address the patient’s oxygen saturation followed by the patient’s hypotension.
Rationale:
1st Priority: Oxygen Saturation → The client’s oxygen saturation has dropped to 88% on room air, which is below the expected range (typically ≥95% in healthy individuals). Hypoxia must be addressed immediately to prevent further complications. The nurse should apply supplemental oxygen and reassess respiratory status.
2nd Priority: Hypotension → The client’s blood pressure has dropped to 94/59 mmHg, which is significantly lower than the earlier reading of 102/76 mmHg. This may contribute to dizziness and syncope. The nurse should monitor for signs of hemodynamic instability, assess for ongoing blood loss (related to heavy menstrual bleeding), and anticipate interventions such as IV fluids or further evaluation for anemia-related hypotension.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Peripheral edema is more common in heart failure, not polycythemia vera.
B. WBCs may be elevated, but RBC overproduction is the defining feature.
C. Orthopnea is associated with heart failure, not polycythemia vera.
D. Elevated hemoglobin is a hallmark of polycythemia vera due to excessive RBC production.
Correct Answer is A
Explanation
A. Avoid alcoholic beverages. – Correct Answer. Alcohol can lower the seizure threshold and interfere with antiepileptic medications.
B. Take tub baths instead of showers. – Incorrect. Showers are safer because a seizure in a bathtub increases the risk of drowning.
C. When the seizures stop, discontinue the medication. – Incorrect. Antiepileptic drugs should not be stopped abruptly, even if seizures are well controlled.
D. Continue to take OTC medications as needed. – Incorrect. Some OTC medications can interact with antiepileptic drugs, so a healthcare provider should be consulted before use.
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