After receiving a change-of-shift report about the following four patients on the cardiac care unit, which patient would the nurse assess first?.

A 65-year-old patient who had a myocardial infarction (MI) 4 days ago and is anxious about today's planned discharge.

A 59-year-old patient with unstable angina who has just returned after a percutaneous coronary intervention (PCI).

A 56-year-old patient with variant angina who is scheduled to receive nifedipine (Procardia).

A 39-year-old patient with pericarditis who is complaining of sharp, stabbing chest pain.

Answer and Explanation

The Correct Answer is B

Choice A rationale:

A patient who had a myocardial infarction (MI) 4 days ago and is anxious about today’s planned discharge would need reassurance and education, but it’s not an immediate concern.

Choice B rationale:

A patient with unstable angina who has just returned after a percutaneous coronary intervention (PCI) is at risk for hemorrhage from the arterial access site. Immediate assessment of blood pressure, pulses, and the access site is required.

Choice C rationale:

A patient with variant angina who is scheduled to receive nifedipine (Procardia) would need monitoring, but it’s not the most urgent.

Choice D rationale:

A patient with pericarditis complaining of sharp, stabbing chest pain would need evaluation, but the risk of complications is less immediate than for Choice B1.

So, the correct answer is B, after analyzing all choices.

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

Explanation

Choice A rationale:

Obtaining blood cultures x 3 is anticipated for the client. This is because the adolescent’s symptoms such as fever, shortness of breath, and petechiae could indicate a bacterial infection, possibly endocarditis, which is a risk for individuals with a history of rheumatic fever and cardiac valve damage. Blood cultures would help identify the causative bacteria.

Choice B rationale:

Administering antibiotic therapy is anticipated for the client. The adolescent’s symptoms suggest a possible bacterial infection, which could have been introduced during the recent dental work. Antibiotics would help eliminate the bacteria and prevent further complications.

Choice C rationale:

Obtaining an echocardiogram is anticipated for the client. Given the adolescent’s history of rheumatic fever and cardiac valve damage, and current symptoms like shortness of breath and chest pain, an echocardiogram would help assess the condition of the heart valves and detect any abnormalities.

Choice D rationale:

Restricting dental hygiene is contraindicated for the client. Good oral hygiene is important, especially for individuals with a history of rheumatic fever and cardiac valve damage, as it helps prevent oral infections that could potentially spread to the heart.

Choice E rationale:

Performing a strenuous exercise regimen twice daily is contraindicated for the client. The adolescent is currently experiencing symptoms like shortness of breath and chest pain, which could be exacerbated by strenuous exercise. It’s important to avoid overexertion until the adolescent’s condition stabilizes.

So, the correct answer is, after analyzing all choices, Choices A, B, and C are anticipated for the client, while Choices D and E are contraindicated. .

A. "The pain is level 3 to 5 (0 to 10 scale).”. B. "The pain has gotten worse over the last week.”. C. "The pain wakes me up at night.”. D. "The pain goes away with a nitroglycerin tablet.”. .

Correct Answer is D

Explanation

Choice A rationale:

The pain level of 3 to 5 on a scale of 0 to 10 does not specifically indicate chronic stable angina.

Choice B rationale:

Pain that has worsened over the last week could indicate a number of conditions, not specifically chronic stable angina.

Choice C rationale:

Pain that wakes a patient up at night could be a sign of a number of conditions, not specifically chronic stable angina.

Choice D rationale:

Chronic stable angina is characterized by chest pain that is relieved by rest or nitroglycerin. Therefore, if the patient’s pain goes away with a nitroglycerin tablet, it would help confirm a diagnosis of chronic stable angina.

So, the correct answer is Choice D, after analyzing all choices.

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After receiving a change-of-shift report about the following four patients on the cardiac care unit, which patient would the nurse assess first?.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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

Explanation

Which patient statement would help the nurse confirm the previous diagnosis of chronic stable angina?.

Correct Answer is D

Explanation

A nurse is caring for an adolescent following a cardiac catheterization. Exhibits Which of the following assessment findings should the nurse report to the provider? Select the 4 findings that the nurse should report to the provider.

The nurse is providing teaching about the patient's laboratory values that increase the risk for coronary artery disease (CAD). Which of the following values should the nurse prioritize?.

The nurse is administering a thrombolytic agent to a patient having an acute myocardial infarction. Which patient data indicates that the nurse should stop the drug infusion?.

After reviewing a patient's history, vital signs, physical assessment, and laboratory data, which information is most important for the nurse to communicate to the health care provider?.

Which patient statement indicates that the nurse's teaching about sublingual nitroglycerin (Nitrostat) has been effective?.

The nurse is assessing a patient with myocarditis before giving a scheduled dose of digoxin (Lanoxin). Which finding is most important for the nurse to communicate to the health care provider?.

After receiving a change-of-shift report on four patients, which patient would the nurse assess first?.

A patient who has chronic heart failure is admitted to the emergency department with severe dyspnea and a dry, hacking cough. Which action would the nurse take first?.