The nurse cares for a client with diabetes mellitus and congestive heart failure.
Which two (2) client findings in the history and physical are most concerning? Select all that apply
Oral temperature
Thready pulse
Reports of thirst
Recently lost his job
Medical history of CHF
Correct Answer : B,D
Choice A rationale: While the temperature is important in assessing health, it isn't the most concerning finding in this scenario compared to others.
Choice B rationale: A thready pulse (a weak, barely palpable pulse) could indicate a critical drop in blood pressure and cardiac output, which is a significant concern.
Choice C rationale: While indicating a possible issue with hydration, it's not as immediately concerning as other findings in this context.
Choice D rationale: Recently lost his job - While this has social and economic implications, it's not an immediate physiological concern in this clinical scenario.
Choice E rationale: While significant in his overall health, it's not a direct finding from the current assessment that immediately raises concern.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale: This test is not specific for confirming osteoporosis.
Choice B rationale: This test is called a bone mineral density (BMD) test or a dual-energy X-ray absorptiometry (DXA) scan. It measures how much calcium and other minerals are in a segment of bone.
Choice C rationale: This test is not specific for confirming osteoporosis.
Choice D rationale: This test is not specific for confirming osteoporosis.

Correct Answer is C
Explanation
Choice A rationale: This question is not relevant to BPH, as erectile dysfunction is not a common complication of this condition. Erectile dysfunction can have other causes, such as cardiovascular disease, diabetes, medications, psychological factors, or aging.
Choice B rationale: This question is not relevant to BPH, as penile discharge is not a symptom of this condition. Penile discharge can indicate an infection, such as sexually transmitted diseases, urinary tract infections, or prostatitis.
Choice C rationale: BPH is a condition that causes enlargement of the prostate gland, which can obstruct the flow of urine and cause symptoms such as difficulty in starting or stopping urination, weak or intermittent stream, dribbling, and incomplete bladder emptying. Asking about the force of the urinary stream can help assess the severity of BPH and the need for treatment.
Choice D rationale: This question is not relevant to BPH, as sexual function is not directly affected by this condition. However, some men with BPH may experience reduced libido or satisfaction due to urinary symptoms or psychological distress.
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