The nurse is caring for a client following a cardiac angiogram (catheterization). It would be most important for the nurse to assess the client for:
Bleeding at the arterial puncture site.
Cardiac dysrhythmias related to catheter insertion.
Electrolyte imbalances related to dye injection.
Discomfort at the catheter insertion site.
The Correct Answer is A
Choice a reason:
Bleeding at the arterial puncture site is a primary concern post-cardiac angiogram, as it can lead to significant blood loss and hematoma formation. The nurse must frequently monitor the site for any signs of bleeding or hematoma, apply pressure if necessary, and report any abnormalities to the physician immediately.
Choice b reason:
Cardiac dysrhythmias may occur due to irritation of the heart muscle by the catheter during insertion. Monitoring the client's heart rhythm is essential to detect any new onset of arrhythmias, which could indicate complications from the procedure.
Choice c reason:
Electrolyte imbalances can result from the contrast dye used during a cardiac angiogram. The dye can affect kidney function, leading to changes in electrolyte levels. Monitoring electrolyte levels is important to prevent complications such as arrhythmias or fluid imbalances.
Choice d reason:
While discomfort at the catheter insertion site is expected, it is typically mild. However, the nurse should assess for discomfort as it may indicate other issues such as infection, bleeding, or a reaction to the procedure.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason:
Reviewing the diet and exercise guidelines with the client is an important step, but it may not address the immediate issue of the weight loss plateau. It's essential to first understand if the client has adhered to the guidelines before reviewing them.
Choice B reason:
Asking the client about any changes in diet or exercise patterns is the first step in identifying potential causes for the weight loss plateau. Changes in lifestyle, stress levels, eating habits, or physical activity can all contribute to a halt in weight loss. Understanding these factors can help the nurse tailor further advice and support.
Choice C reason:
Recommending a further reduction in calorie intake might not be the best initial approach. It's important to ensure that the client is not already consuming too few calories, which can slow metabolism and hinder weight loss. Moreover, drastic calorie reduction can be unsustainable and lead to nutritional deficiencies.
Choice D reason:
Instructing the client to record weights weekly is a useful tool for monitoring progress, but it does not address the current issue of the weight loss plateau. It's a supportive action that should follow after understanding and addressing the reasons behind the plateau.
Correct Answer is C
Explanation
Choice A Reason
Increasing sodium intake is not recommended for patients who have passed a calcium oxalate stone. High sodium intake can increase calcium in the urine, which can contribute to the formation of new stones. Therefore, patients are often advised to limit their sodium intake to reduce the risk of stone recurrence.
Choice B Reason
Considering a move to an area with higher humidity is not a standard recommendation for preventing the recurrence of calcium oxalate stones. While climate can affect hydration levels, it is more important for the patient to focus on direct measures to stay hydrated, such as drinking more fluids.
Choice C Reason
Increasing water intake is a key recommendation for patients who have had calcium oxalate stones. Adequate hydration is essential to dilute the urine, which helps prevent the formation of new stones. Patients are often advised to drink enough water to produce at least 2.5 liters of urine per day.
Choice D Reason
Decreasing the intake of all calcium-rich foods and beverages is not generally recommended for patients with calcium oxalate stones. In fact, a moderate intake of dietary calcium can help reduce the risk of stone formation by binding with oxalate in the intestines, which prevents it from being absorbed into the urine. Patients should consult with a healthcare provider or dietitian to determine the appropriate amount of dietary calcium.
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