A nurse is collecting data on a client who has a heart rate of 44/min.
Which of the following findings should the nurse expect?

Temperature of 39°C (102.2°F)

History of cigarette smoking.

Patient reports they feel that they are going to pass out.

Hypoglycemia.

Answer and Explanation

The Correct Answer is C

Choice A rationale:

Temperature of 39°C (102.2°F) A temperature of 39°C (102.2°F) is elevated, but it is not directly related to a heart rate of 44/min. Elevated temperature can be caused by various factors, such as infection, and would not be an expected finding solely due to the heart rate.

Choice B rationale:

History of cigarette smoking. A history of cigarette smoking may be a risk factor for certain cardiovascular conditions, but it does not directly explain a heart rate of 44/min. The heart rate can be influenced by factors such as medications, cardiac conditions, and autonomic nervous system activity.

Choice D rationale:

Hypoglycemia. Hypoglycemia (low blood sugar) can cause various symptoms, including shakiness, confusion, and sweating, but it is not the primary cause of a heart rate of 44/min. Hypoglycemia is more likely to cause symptoms related to altered mental status and autonomic nervous system activation.

Choice C rationale:

Patient reports they feel that they are going to pass out. A heart rate of 44/min is significantly lower than the normal range for adults, which is typically between 60-100 beats per minute. Such a low heart rate, known as bradycardia, can lead to decreased blood flow to vital organs, including the brain. Feeling like they are going to pass out is a concerning symptom associated with bradycardia because it suggests inadequate cardiac output and perfusion. This finding should prompt immediate assessment and intervention to address the underlying cause of the slow heart rate.

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Correct Answer is D

Explanation

Choice A rationale:

The client does not need an oxygen mask for a low flow rate of 1 to 2 L/min. Oxygen masks are typically used for higher flow rates and may not be comfortable or necessary for a client requiring such a low oxygen flow.

Choice B rationale:

A reservoir bag is not required for a client receiving low flow oxygen at 1 to 2 L/min. Reservoir bags are commonly used with oxygen masks at higher flow rates to ensure a consistent supply of oxygen during inhalation.

Choice C rationale:

Petroleum jelly is not a necessary supply for a client prescribed home oxygen at 1 to 2 L/min. Its use may not be recommended due to the risk of flammability in the presence of oxygen.

Choice D rationale:

The correct choice is D. The client should have a nasal cannula as a supply upon discharge. A nasal cannula is the appropriate delivery device for low flow oxygen therapy at 1 to 2 L/min. It is comfortable and allows for adequate oxygen supplementation for the client.

A. "I need to use iodine to disinfect cuts on my feet.” B. "I will wear a clean pair of cotton socks each day.” C. "I should soak my feet in warm water every morning.” D. "I can remove ingrown toenails at home as needed.”

Correct Answer is B

Explanation

Choice A rationale:

Using iodine to disinfect cuts on the feet is not recommended for individuals with diabetes. Iodine can be harsh and may delay wound healing. It's better to clean cuts with mild soap and water and consult a healthcare professional for proper wound care.

Choice B rationale:

Wearing a clean pair of cotton socks each day is an excellent practice for someone with diabetes. Cotton socks can help absorb moisture and reduce the risk of fungal infections and pressure sores.

Choice C rationale:

Soaking feet in warm water every morning is not recommended for individuals with diabetes, as it can lead to skin drying and cracking. It's better to soak feet in lukewarm water occasionally, not daily, and to moisturize afterward.

Choice D rationale:

Attempting to remove ingrown toenails at home is not advisable for individuals with diabetes, as it can lead to infection and complications. Clients with diabetes should seek professional foot care for any foot issues, including ingrown toenails.

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A nurse is collecting data on a client who has a heart rate of 44/min.Which of the following findings should the nurse expect?

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A nurse is collecting data on a client who has a heart rate of 44/min.
Which of the following findings should the nurse expect?