During the nursing assessment of a patient with Graves' disease. The nurse notes a bounding, rapid pulse and systolic hypertension. Based on these assessment data, which question is important for the nurse to ask the patient?
“Do you ever have any chest pain?'
“Have you noticed any recent decrease in your appetite?”
“Do you have any problem with frequent constipation?”
The Correct Answer is A
The patient's bounding, rapid pulse and systolic hypertension may indicate cardiovascular complications associated with Graves' disease, such as tachycardia, atrial fibrillation, or congestive heart failure, which can cause chest pain. It is important for the nurse to assess for any symptoms of cardiovascular distress and report any abnormal findings to the healthcare provider for prompt intervention. Questions about appetite and constipation may be relevant to the patient's overall health status, but they are not the most important concern in this situation.
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Related Questions
Correct Answer is A
Explanation
The nurse will include the instruction "Offer the client the commode or urinal every 2 hours" in the teaching plan for the client's family. This approach is known as timed voiding and can help the client re-establish a regular pattern of urination. Option "a" promotes frequent voiding, which helps
prevent accidents and promotes bladder health. Option "b" is not a recommended approach and can lead to dehydration, urinary tract infections, and other complications. Option "c" is also not recommended since holding urine for extended periods can lead to bladder distention and increase the risk of urinary tract infections. Option "d" is also not recommended since catheterization should only be considered in specific cases where other options have failed or are not feasible.
Correct Answer is A
Explanation
The first step in the education plan should be to assess their understanding and perception of the disease. This will help the nurse to identify any misconceptions or knowledge gaps that the patient may have and tailor the education plan accordingly. Understanding the patient's perceptions will also help the nurse to establish a trusting relationship with the patient and increase their engagement in diabetes self-management.
Options b, c, and d are important components of the diabetes education plan, but they should be implemented after the initial assessment of the patient's perception and understanding of their diagnosis.
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