One hour following cardiac catheterization via the left femoral site, a client reports feeling weak and dizzy. Assessment reveals that the client's dressing is dry and intact. Which action should the nurse take next?
Measure vital signs and telemetry pattern.
Palpate and compare pedal pulse volumes.
Measure post-procedure intake and output.
Remove the dressing and observe the site.
The Correct Answer is A
Choice A reason: After cardiac catheterization, monitoring the client's vital signs and telemetry pattern is crucial, especially when symptoms like weakness and dizziness are reported. These symptoms could indicate serious complications such as bleeding, arrhythmia, or cardiac tamponade. Monitoring vital signs can help detect hypotension, hemorrhage, or other hemodynamic instabilities. Telemetry is crucial for detecting arrhythmias that may require immediate intervention.
Choice B reason: Palpating and comparing pedal pulse volumes is an important step to assess for vascular complications such as thrombosis or embolism. However, it is not the immediate priority when a client reports systemic symptoms like weakness and dizziness, which could be signs of more serious conditions.
Choice C reason: Measuring post-procedure intake and output is part of routine postoperative care to ensure proper fluid balance. While important, it is not the most critical action to take when a client is experiencing acute symptoms that could indicate life-threatening complications.
Choice D reason: Removing the dressing and observing the site might be indicated if there is suspicion of bleeding or hematoma formation at the catheterization site. However, since the dressing is reported to be dry and intact, and the client is experiencing systemic symptoms, the priority is to assess for potential systemic complications first.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Advising the client to maintain bedrest may not be practical or beneficial for the client's overall health and does not address the UAP's concern about safe transfer.
Choice B reason: While it is true that all clients deserve equal care, this statement does not provide a solution to the UAP's concern about safely assisting the client.
Choice C reason: Determining the client's level of mobility and need for assistance will help in creating a safe and effective plan for transferring the client to the bedside commode.
Choice D reason: Assigning another UAP may be necessary if the current UAP is unable to assist safely, but it is not the first step. The nurse should first assess the situation before making staffing changes.
Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"B"}
Explanation
Choice A Reason: Decreasing portion sizes can help manage calorie intake and contribute to weight loss, which is beneficial for individuals with prediabetes or diabetes. Proper portion control is also essential for maintaining blood sugar levels within the target range.
Choice B Reason: Avoiding potassium-rich foods is not a standard dietary recommendation for diabetes management unless the individual has a specific condition like kidney disease that requires potassium restriction.
Choice C Reason: Eating only plant-based foods is not necessary for diabetes management. While a plant-based diet can be part of a healthy eating plan, it is not required for all individuals with diabetes.
Choice D Reason: Choosing a well-rounded diet ensures that all necessary nutrients are included, which is important for overall health and can help manage blood sugar levels. A balanced diet for diabetes should include a variety of foods from all food groups.
Choice E Reason: Eliminating carbohydrates is not recommended for diabetes management. Carbohydrates are a necessary part of a healthy diet, and individuals with diabetes should focus on the type and amount of carbohydrates consumed rather than eliminating them entirely.
Choice F Reason: Replacing refined sugar with honey or molasses is not necessarily beneficial for diabetes management. While these are natural sweeteners, they still affect blood sugar levels and should be used in moderation.
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