In planning care for the patient with acute myocardial infarction (AMI), the nurse identifies the highest priority goal of care as which of the following?
Stable ECG rhythm
Ability to verbalize causes and effects of CHD/CAD
Adequate relief of pain
Compliance with prescribed bedrest
The Correct Answer is C
Choice A reason: While a stable ECG rhythm is important, it is not the immediate concern post-AMI.
Choice B reason: The ability to verbalize causes and effects of CHD/CAD is an educational goal, not an immediate care priority.
Choice C reason: Adequate relief of pain is a priority to reduce stress on the heart and improve patient comfort.
Choice D reason: Compliance with prescribed bedrest is important but secondary to pain relief.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: A healthy stoma should be beefy red and moist, indicating good blood supply and hydration.
Choice B reason: A dusky maroon color could indicate compromised blood supply or ischemia.
Choice C reason: A pale and pink stoma may suggest anemia or reduced blood flow.
Choice D reason: A stoma that is pink and dry could be dehydrated, which is not ideal.
Correct Answer is D
Explanation
Choice A reason: The annual pneumococcal vaccine is recommended for preventing pneumococcal disease, which can be a complication of COPD, but it is not a primary prevention method for COPD itself.
Choice B reason: Maintaining ideal weight is important for overall health but is not directly related to the prevention of COPD.
Choice C reason: The annual influenza vaccine can help prevent flu-related complications in individuals with COPD but is not a primary prevention method for COPD.
Choice D reason: Stopping or cutting back on smoking is the most effective way to prevent COPD, as smoking is the leading cause of the disease.
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