In conducting a health history for a client with erythema, the nurse would include which question?
Do you ever use oxygen?
How many pillows do you sleep on?
Do you feel rested after sleeping?
How far can you walk before feeling short of breath?
The Correct Answer is A
Choice A reason: The nurse would include the question of whether the client ever uses oxygen, as this can be related to erythema. Erythema is a condition where the skin becomes red and inflamed due to increased blood flow or irritation. ¹ One possible cause of erythema is oxygen toxicity, which is a condition where the lungs and tissues are damaged by exposure to high levels of oxygen. ² The nurse would ask the client if they ever use oxygen, especially at high concentrations or for long periods of time, as this can increase the risk of oxygen toxicity and erythema.
Choice B reason: The nurse would not include the question of how many pillows the client sleeps on, as this is not related to erythema. The number of pillows the client sleeps on may indicate the presence of other conditions, such as sleep apnea, acid reflux, or heart failure, but not erythema. ³ The nurse would ask the client about their sleeping habits and preferences, but not specifically about the number of pillows they use.
Choice C reason: The nurse would not include the question of whether the client feels rested after sleeping, as this is not related to erythema. The feeling of restfulness after sleeping may indicate the quality and quantity of sleep the client gets, which can affect their overall health and well-being, but not erythema. The nurse would ask the client about their sleep patterns and problems, but not specifically about their feeling of restfulness.
Choice D reason: The nurse would not include the question of how far the client can walk before feeling short of breath, as this is not related to erythema. The distance the client can walk before feeling short of breath may indicate the level of physical activity and fitness the client has, which can affect their cardiovascular and respiratory health, but not erythema. The nurse would ask the client about their exercise habits and limitations, but not specifically about their walking distance.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Avoiding strenuous activity and standing up slowly is not a relevant response to the client's complaint of headache. These actions may help prevent or reduce orthostatic hypotension, which is another possible side effect of nitroglycerin, but not headache.
Choice B reason: Headache is expected and should subside with continued use is a correct and appropriate response to the client's complaint of headache. The nurse should explain that headache is a common and transient side effect of nitroglycerin, which is caused by the vasodilation effect of the drug. The nurse should also advise the client to take over-the-counter analgesics, such as acetaminophen, to relieve the headache.
Choice C reason: Reducing the dosage to help relieve this side effect is not a correct or appropriate response to the client's complaint of headache. The nurse should not suggest any changes in the prescribed dosage of nitroglycerin, as this may compromise the effectiveness of the drug and increase the risk of angina or myocardial infarction. The nurse should also remind the client to follow the instructions for applying and removing the Nitropatch.
Choice D reason: You will have this side effect as long as you are taking nitroglycerin is not a correct or appropriate response to the client's complaint of headache. The nurse should not discourage or alarm the client by implying that the headache is inevitable and permanent. The nurse should reassure the client that the headache will likely diminish over time as the body adapts to the drug.
Correct Answer is C
Explanation
Choice A reason: An early morning headache is not the most common side effect of lisinopril. Lisinopril is a drug that lowers blood pressure and prevents the complications of heart failure. ¹ It belongs to a class of drugs called angiotensin-converting enzyme (ACE) inhibitors, which work by relaxing the blood vessels and reducing the workload of the heart. ¹ Headache is a possible side effect of lisinopril, but it is not very frequent or specific to this drug. ²
Choice B reason: Occasional nausea is not the most common side effect of lisinopril. Lisinopril is a drug that lowers the blood pressure and prevents the complications of heart failure. ¹ It belongs to a class of drugs called angiotensin-converting enzyme (ACE) inhibitors, which work by relaxing the blood vessels and reducing the workload of the heart. ¹ Nausea is a possible side effect of lisinopril, but it is not very frequent or specific to this drug. ²
Choice C reason: A chronic cough is the most common side effect of lisinopril. Lisinopril is a drug that lowers the blood pressure and prevents the complications of heart failure. ¹ It belongs to a class of drugs called angiotensin-converting enzyme (ACE) inhibitors, which work by relaxing the blood vessels and reducing the workload of the heart. ¹ However, ACE inhibitors can also cause a dry, persistent cough that does not go away with time or treatment. ² This cough is due to the accumulation of a substance called bradykinin in the lungs, which irritates the airways and triggers the cough reflex. ³ The cough can be annoying and interfere with the quality of life of the client, but it is not harmful or dangerous. ²
Choice D reason: A dry mouth after eating is not the most common side effect of lisinopril. Lisinopril is a drug that lowers the blood pressure and prevents the complications of heart failure. ¹ It belongs to a class of drugs called angiotensin-converting enzyme (ACE) inhibitors, which work by relaxing the blood vessels and reducing the workload of the heart. ¹ Dry mouth is a possible side effect of lisinopril, but it is not very frequent or specific to this drug. ² Dry mouth can be caused by many factors, such as dehydration, medication, or disease. It can be relieved by drinking water, chewing gum, or using saliva substitutes.
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