The nurse is caring for a group of patients. Which of the the following patients should the nurse evaluate first?

A patient with coronary artery disease (CAD) who reports chest pain radiating to the jaw.

A patient with venous insufficiency with 2+ pitting edema.

A patient receiving enoxaparin (Lovenox) for experiencing an MI 3 days ago.

A patient with peripheral artery disease (PAD) with a diminished pulse.

Answer and Explanation

The Correct Answer is A

A. A patient with coronary artery disease (CAD) who reports chest pain radiating to the jaw: This patient should be evaluated first. Chest pain radiating to the jaw can be a sign of a heart attack, which is a life-threatening condition. Immediate medical attention is required to prevent further damage to the heart muscle.

B. A patient with venous insufficiency with 2+ pitting edema: While this patient’s condition needs to be addressed, it is not as immediately life-threatening as a potential heart attack. Venous insufficiency and edema can lead to discomfort and complications if left untreated, but these complications are typically not immediate.

C. A patient receiving enoxaparin (Lovenox) for experiencing an MI 3 days ago: This patient is already receiving treatment for their condition. While they should be monitored for side effects of the medication and signs of further cardiac issues, they are not the highest priority based on the information given.

D. A patient with peripheral artery disease (PAD) with a diminished pulse: While a diminished pulse can indicate poor blood flow, which can lead to complications such as tissue damage and non-healing wounds, it is not as immediately life-threatening as a potential heart attack. This patient should be evaluated, but they are not the highest priority based on the information given.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is B

Explanation

A) Mannitol:
Mannitol is an osmotic diuretic that works by increasing the osmotic pressure in the glomerular filtrate, leading to increased urine output. It is not associated with causing hyperkalemia.

B) Spironolactone:
This is the correct choice. Spironolactone is a potassium-sparing diuretic that can put clients at risk for hyperkalemia. It works by blocking the action of aldosterone in the distal tubules of the kidneys, leading to decreased sodium reabsorption and increased potassium retention.

C) Hydrochlorothiazide:
Hydrochlorothiazide is a thiazide diuretic that promotes the excretion of sodium and water and can lead to potassium depletion (hypokalemia) rather than hyperkalemia.

D) Furosemide:
Furosemide is a loop diuretic that inhibits sodium and chloride reabsorption in the ascending loop of Henle. It can lead to potassium depletion (hypokalemia) rather than hyperkalemia.

A. A client's response to interventions implemented. B. The frequency in which a blood pressure is taken. C. Interventions implemented in response to a client's blood pressure. D. The site where the blood pressure was obtained. E. A client's position when the blood pressure was obtained.

Correct Answer is ["A","B","C","D","E"]

Explanation

A) A client's response to interventions implemented: It's essential to document how the client responds to interventions implemented in response to their blood pressure. This provides valuable information on the effectiveness of the interventions and helps in assessing the client's condition.

B) The frequency in which a blood pressure is taken: Documenting the frequency of blood pressure measurements is crucial for tracking trends and changes over time. It ensures a comprehensive assessment of the client's cardiovascular status.

C) Interventions implemented in response to a client's blood pressure: Documenting the interventions implemented in response to a client's blood pressure helps in maintaining an accurate record of the care provided and ensures continuity of care among healthcare providers.

D) The site where the blood pressure was obtained: Documenting the site where the blood pressure was obtained is important for standardizing the measurement process and ensuring consistency. Common sites include the brachial artery, but documenting the specific site provides clarity and accuracy.

E) A client's position when the blood pressure was obtained: Documenting the client's position during blood pressure measurement is essential because blood pressure can vary based on body position. It ensures that accurate comparisons can be made between readings and provides valuable information for clinical decision-making.

View Question and Answer

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

The nurse is caring for a group of patients. Which of the the following patients should the nurse evaluate first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assisting with a presentation about caring for clients who are receiving diuretic therapy. The nurse should explain that which of the following medications can put clients at risk for hyperkalemia?

Correct Answer is B

Explanation

A nurse is assisting with teaching a class about documenting blood pressure. The nurse should include to document which of the following information? (Select All that Apply)

Correct Answer is ["A","B","C","D","E"]

Explanation

The nurse is sitting at the desk watching the telemetry monitors and notes a patient's rhythm suddenly shows asystole. Which action should the nurse take first?

A nurse is giving change-of-shift report using the SBAR technique about a client who has a traumatic brain injury. When reporting information about the client, which of the following should the nurse include in the situation segment of SBAR?

A nurse is caring for four clients at an urgent care center. Which of the following clients should the nurse suspect has been physically abused?

A nurse is reinforcing preoperative teaching with a client who is to undergo open abdominal surgery. Which of the following interventions should the nurse include to prevent of postoperative complications?

A nurse is contributing to the plan of care for a client who has had HIV for 10 years and is at the end of life. Which of the following interventions should the nurse recommend?

A nurse is working with a social worker and a physical therapist in preparing a discharge projection for a client who is postoperative. Which of the following steps of the nursing process is the nurse engaging in?

A nurse is caring for a client who has a prescription for metoprolol. The nurse measures the client's vital signs and notes that the client's apical heart rate is 49/min. The nurse should prepare to administer which of the following medications?