A patient who is diagnosed with a stroke is requesting a glass of water. Which action is appropriate for the nurse to take?

Give the patient a glass of water.

Check the patient's dysphagia screen

Consult speech pathology.

Teach that stroke patients are nothing by mouth (NPO)

Answer and Explanation

The Correct Answer is B

A. Give the patient a glass of water.: Giving the patient water without assessing their swallowing ability can be dangerous due to the risk of aspiration.
B. Check the patient's dysphagia screen.: Assessing for dysphagia is crucial because stroke patients often have impaired swallowing, which increases the risk of aspiration and choking.
C. Consult speech pathology.: Consulting a speech pathologist is important for a comprehensive swallowing assessment, but it is not the immediate action when a patient requests water.
D. Teach that stroke patients are nothing by mouth (NPO).: Not all stroke patients are NPO. This decision is based on the patient's ability to swallow safely, determined by a dysphagia screen.

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Correct Answer is A

Explanation

A. I will walk 20 minutes every other day: This is correct. Walking is a safe, low-impact activity that promotes cardiovascular health without placing undue stress on the abdominal area, which is important for a patient with an AAA.
B. Instead of taking my car, I will ride my bike everywhere: Biking can be too strenuous and risky for someone with an AAA, as it may involve physical exertion and potential for trauma to the abdominal area.
C. I am starting back to work as a grocery store stocker next week: This job likely involves heavy lifting and significant physical activity, which is contraindicated for a patient with an AAA due to the risk of increased intra-abdominal pressure and potential aneurysm rupture.
D. I am going to continue my marathon training tomorrow: Marathon training is highly strenuous and can significantly increase blood pressure and stress on the abdominal region, posing a high risk of aneurysm rupture.

A. Hemorrhage B. Elevated blood urea nitrogen and creatinine C. Infection D. Fat embolism syndrome E. Elevated serum potassium

Correct Answer is ["A","C","D"]

Explanation

A. Hemorrhage: This is correct. Fractures, especially in large bones like the femur or pelvis, can cause significant bleeding, either internally or externally.
B. Elevated blood urea nitrogen and creatinine: This is not directly related to fractures. These values indicate kidney function and are not typical complications of fractures.
C. Infection: This is correct. Open fractures and surgical interventions for fractures can lead to infections, including osteomyelitis.
D. Fat embolism syndrome: This is correct. Fat embolism syndrome can occur when fat globules from bone marrow enter the bloodstream, typically after fractures of long bones or the pelvis, and cause serious complications.
E. Elevated serum potassium: This is not typically a direct complication of fractures. Elevated potassium can occur due to other factors, such as crush injuries or tissue necrosis, but is not a common concern with simple fractures.

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A patient who is diagnosed with a stroke is requesting a glass of water. Which action is appropriate for the nurse to take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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