The nurse asks a client who is about to have a cardiac catheterization about any allergies. The client states, "I always get a rash when I eat shellfish." Which of the following is the priority nursing action?
Ask the client if any other foods cause such a reaction.
Notify the provider of the client's allergy.
Notify the dietary department of the client's allergy.
Atach a wrist band indicating the client's allergy.
The Correct Answer is B
The priority nursing action is to notify the provider of the client's allergy because shellfish allergy may indicate an allergy to iodine, which is commonly used as a contrast dye in cardiac catheterization. This could cause a severe allergic reaction or anaphylaxis during the procedure, which could be life-threatening. The provider may need to order a different type of contrast dye or premedicate the client with antihistamines or steroids to prevent an allergic reaction.
a. Ask the client if any other foods cause such a reaction is wrong because it is not the priority action and it does not address the potential risk of iodine allergy.
c. Notify the dietary department of the client's allergy is wrong because it is not relevant to the cardiac catheterization and it does not prevent an allergic reaction during the procedure.
d. Atach a wrist band indicating the client's allergy is wrong because it is not sufficient to alert the provider or the catheterization team of the client's allergy and it does not prevent an allergic reaction during the procedure.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Aortic stenosis is a narrowing of the aortic valve that obstructs blood flow from the left ventricle to the aorta. This causes increased pressure in the left ventricle, which can lead to left ventricular hypertrophy and reduced cardiac output. Symptoms of aortic stenosis include dyspnea, fatigue, chest pain, syncope, and palpitations. Tachycardia and weak peripheral pulses are signs of decreased cardiac output.
The other options are not correct because:
- Asthma is a chronic inflammatory disorder of the airways that causes bronchoconstriction, mucus production, and wheezing. It does not affect the heart valves or cardiac output.
- Aortic valve regurgitation is a leakage of blood back into the left ventricle from the aorta during diastole. This causes volume overload and increased pressure in the left ventricle, which can lead to left ventricular dilation and heart failure. Symptoms of aortic valve regurgitation include dyspnea, orthopnea, palpitations, and a high-pitched blowing diastolic murmur. Peripheral pulses are typically bounding and pulse pressure is widened.
- Heart failure is a syndrome of impaired cardiac function that results in inadequate perfusion of tissues. It can be caused by various cardiac disorders, such as coronary artery disease, hypertension, cardiomyopathy, or valvular disease. Symptoms of heart failure include dyspnea, fatigue, edema, orthopnea, paroxysmal nocturnal dyspnea, and crackles in the lungs. Peripheral pulses may be weak or normal depending on the type and severity of heart failure.
Correct Answer is B
Explanation
The P wave is the first wave on the ECG strip and represents the electrical activity of the atria. It reflects the depolarization of the atrial myocardium, which is the process of changing the electrical charge of the cardiac cells from negative to positive, triggering a contraction. The P wave precedes the QRS complex, which represents ventricular depolarization, and the T wave, which represents ventricular repolarization.
The other options are not correct because:
a. Slow repolarization of ventricular Purkinje fibers. This statement is incorrect because it describes the U wave, which is a small and sometimes invisible wave that follows the T wave on the ECG strip. It reflects the repolarization of the ventricular Purkinje fibers, which are specialized cardiac cells that conduct electrical impulses to the ventricles. The U wave is more prominent in conditions that cause hypokalemia, such as diuretic use or vomiting.
c. Early ventricular repolarization. This statement is incorrect because it describes the ST segment, which is the flat line between the QRS complex and the T wave on the ECG strip. It reflects the early phase of ventricular repolarization, which is the process of restoring the electrical charge of the cardiac cells to negative after a contraction. The ST segment can be elevated or depressed in conditions that cause myocardial ischemia or injury, such as angina or myocardial infarction.
d. Ventricular depolarization. This statement is incorrect because it describes the QRS complex, which is the largest and most visible wave on the ECG strip. It reflects the depolarization of the ventricular myocardium, which triggers a ventricular contraction. The QRS complex follows the P wave and precedes the T wave on the ECG strip.
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