The nurse is admitting a client who reports symptoms of dyspnea. The nurse notes edema of the upper arms, face, and neck. What is the nurse's priority assessment?
Degree of upper body vasculature observed.
Arm circumference and degree of edema.
Blood pressure and heart rate.
Peripheral sensation and movement of upper extremities.
The Correct Answer is C
A. Assessing the degree of upper body vasculature may provide some information, but it does not directly address the client's current symptoms or vital status.
B. Measuring arm circumference and evaluating the degree of edema are important for understanding the extent of swelling but do not assess the client’s hemodynamic stability or respiratory status.
C. Blood pressure and heart rate are critical assessments in this scenario, especially considering the client’s dyspnea and upper body edema. Changes in these vital signs can indicate potential respiratory distress, compromised cardiac function, or anaphylaxis, which requires immediate intervention.
D. While assessing peripheral sensation and movement is important for overall neurological function, it is not a priority in this context compared to assessing vital signs that can directly affect the client’s stability.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Increasing fiber intake is generally beneficial for digestive health but alone may not address the client's specific concern regarding colon cancer risk, making this advice too narrow.
B. Discussing family history and early screening options with a primary care provider is crucial, as it can lead to earlier detection and intervention, especially given the family history of colon cancer.
C. The CEA blood test is not routinely used for cancer screening; it is primarily used to monitor treatment response or recurrence, not for predicting the development of cancer.
D. Waiting until the age of 60 to be concerned about colon cancer is not advisable, especially with a family history; proactive discussions about screening should begin earlier based on risk factors.
Correct Answer is ["62.5"]
Explanation
To determine the IV pump rate, we need to calculate the flow rate in milliliters per hour (mL/h).
Given:
- Total volume: 500 mL
- Infusion time: 8 hours
Calculation:
- Flow rate = Total volume / Infusion time
- Flow rate = 500 mL / 8 hours
- Flow rate = 62.5 mL/h
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.