The nurse is caring for a client who is in the later stages of left-sided heart failure. Which chief complaint would the nurse expect the client to report?
Marked limitation with physical activity but comfortable at rest
Angioedema and urticaria
Increased urine output
Chest pain during sleep that is relieved with nitroglycerin
The Correct Answer is A
A. Clients with left-sided heart failure often experience symptoms like shortness of breath, fatigue, and fluid retention, which limit physical activity. However, they may still feel relatively comfortable when resting.
B. These symptoms are more commonly associated with allergic reactions or side effects of medications (such as ACE inhibitors) rather than heart failure.
C. This is not typical in the later stages of left-sided heart failure. In fact, clients may experience reduced urine output due to poor kidney perfusion.
D. Chest pain can occur due to ischemia, but this is not a hallmark symptom of left-sided heart failure, which is more characterized by dyspnea and fatigue.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["5"]
Explanation
(desired dose in mg/hr) / (concentration of medication in mg/mL) = infusion rate in mL/hr.
In this case, the desired dose is 5 mg/hr, and the concentration of medication is 125 mg in 125 mL, which simplifies to 1 mg/mL.
Therefore, the infusion rate is 5 mg/hr divided by 1 mg/mL, resulting in an infusion rate of 5 mL/hr.
Rounding to the nearest whole number, the nurse should set the IV pump to 5 mL/hr.
Correct Answer is C
Explanation
A. “I probably will not have any transfusion reactions from my own blood.” - Autologous transfusions
generally have a lower risk of transfusion reactions because they involve the client’s own blood.
B. “This is the blood I’ve been giving for the past 6 weeks for myself.” - This is a correct understanding of the process of autologous blood donation, where the client donates blood for their own use.
C. An autologous blood transfusion involves the collection and storage of a patient's own blood for later transfusion. This significantly reduces the risk of bloodborne infections, such as hepatitis, HIV, and other blood-borne diseases, as the blood is coming from the patient themselves.
D. “Since I have O negative blood, it’s a good thing I’m getting my own blood.” - The client may not need additional teaching here because O negative blood is universally compatible, but the reason they are getting their own blood is due to the autologous donation process, not because of blood type.
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