After receiving a change-of-shift report, which patient admitted to the emergency department should the nurse assess first?
A 39-year-old patient who has right calf tenderness and swelling after a plane ride
A 58-year-old patient taking anticoagulants for atrial fibrillation who has black stools
A 67-year-old patient who has a gangrenous foot ulcer with a weak pedal pulse
A 50-year-old patient who is reporting sudden sharp and severe upper back pain .
The Correct Answer is D
Choice A rationale
While calf tenderness and swelling after a plane ride could potentially indicate a deep vein thrombosis, this condition is not immediately life-threatening in most cases. The patient would need evaluation and treatment, but other patients might have more urgent needs14.
Choice B rationale
A patient taking anticoagulants for atrial fibrillation who has black stools could potentially have gastrointestinal bleeding, which would need evaluation. However, this condition might not be immediately life-threatening, and other patients might have more urgent needs14.
Choice C rationale
A patient with a gangrenous foot ulcer and a weak pedal pulse would need evaluation and treatment. However, this condition might not be immediately life-threatening, and other patients might have more urgent needs14.
Choice D rationale
A patient reporting sudden sharp and severe upper back pain could potentially have an aortic dissection, which is a life-threatening condition that requires immediate evaluation and treatment. Therefore, this patient should be assessed first14.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Vasotec, an Angiotensin-Converting Enzyme (ACE) inhibitor, is commonly used to treat conditions like high blood pressure and heart failure. It works by relaxing blood vessels, which allows blood to flow more easily and reduces blood pressure.
Choice B rationale
Decreased urine output is not a typical outcome of taking Vasotec. In fact, ACE inhibitors like Vasotec can sometimes increase urine output by improving kidney function.
Choice C rationale
Increased appetite is not a known effect of Vasotec. If a patient experiences a significant change in appetite while taking this medication, they should consult their healthcare provider.
Choice D rationale
Increased fluid retention is not a typical outcome of taking Vasotec. ACE inhibitors like Vasotec are often used to help reduce fluid retention in patients with conditions like heart failure.
Correct Answer is A
Explanation
Choice A rationale
Standing frequently can help promote blood flow in the legs, which can be beneficial for a patient with arterial insufficiency. This is because standing engages the muscles in the legs, which helps push blood back up towards the heart.
Choice B rationale
Walking without shoes is not typically recommended for patients with arterial insufficiency. This is because these patients often have reduced sensation in their feet and may not notice if they step on something sharp or if a wound develops.
Choice C rationale
Vigorous massage of the legs is not usually recommended for patients with arterial insufficiency. While gentle massage can help promote blood flow, vigorous massage could potentially damage the arteries further.
Choice D rationale
Allowing the legs to dangle dependently often is not typically recommended for patients with arterial insufficiency. This position can actually increase swelling and discomfort in the legs.
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