The nurse is caring for a group of patients. Which patient is the priority?

A patient with a BP of 170/80 mm Hg with a mild headache

A patient with a BP of 180/120 mm Hg who is asymptomatic

A patient with a BP of 150/60 mm Hg who is anxious

A patient with a blood pressure (BP) of 140/70 mm Hg who has a nosebleed

Answer and Explanation

The Correct Answer is B

A. A patient with a BP of 170/80 mm Hg with a mild headache: Although high, this BP is not as immediately critical as 180/120 mm Hg. The patient is experiencing only a mild headache, indicating less urgency.
B. A patient with a BP of 180/120 mm Hg who is asymptomatic: This BP level indicates a hypertensive crisis, which can lead to life-threatening complications such as stroke or heart attack, even if the patient is asymptomatic. Immediate intervention is needed to lower the BP safely.
C. A patient with a BP of 150/60 mm Hg who is anxious: This BP is elevated but not critically so. Anxiety management may be necessary but is not as urgent as managing a hypertensive crisis.
D. A patient with a blood pressure (BP) of 140/70 mm Hg who has a nosebleed: This BP is relatively mild compared to 180/120 mm Hg and is less immediately threatening, even with a nosebleed.

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

Explanation

A. Hemorrhage: This is correct. Fractures, especially in large bones like the femur or pelvis, can cause significant bleeding, either internally or externally.
B. Elevated blood urea nitrogen and creatinine: This is not directly related to fractures. These values indicate kidney function and are not typical complications of fractures.
C. Infection: This is correct. Open fractures and surgical interventions for fractures can lead to infections, including osteomyelitis.
D. Fat embolism syndrome: This is correct. Fat embolism syndrome can occur when fat globules from bone marrow enter the bloodstream, typically after fractures of long bones or the pelvis, and cause serious complications.
E. Elevated serum potassium: This is not typically a direct complication of fractures. Elevated potassium can occur due to other factors, such as crush injuries or tissue necrosis, but is not a common concern with simple fractures.

A. tPA is not delivered for hemorrhagic stroke. B. The total effects of ischemia are not currently known. C. Too much time has passed since the symptoms began. D. The patient's symptoms have progressed too quickly.

Correct Answer is A

Explanation

A. tPA is not delivered for hemorrhagic stroke: This is correct. tPA is a thrombolytic medication used for ischemic strokes, not haemorrhagic strokes, as it would exacerbate bleeding.
B. The total effects of ischemia are not currently known: While assessing the extent of ischemia is important for ischemic stroke, it is irrelevant here because the stroke is hemorrhagic.
C. Too much time has passed since the symptoms began: The time window is important for tPA in ischemic strokes, but in this case, the type of stroke (haemorrhagic) is the determining factor.
D. The patient's symptoms have progressed too quickly: The progression of symptoms does not affect the decision to use tPA; the contraindication is solely due to the hemorrhagic nature of the stroke.

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The nurse is caring for a group of patients. Which patient is the priority?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is caring for a patient with a fracture. Which complications should the nurse monitor for? Select all that apply.

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

Explanation

Correct Answer is A

Explanation

Which risk factors would be considered modifiable in the prevention of stroke? Select all that apply.

A patient with peripheral arterial disease (PAD) is sitting in a chair and has cool feet that are reddish-purple in color. What action should the nurse take?

A patient is having difficulty swallowing following a stroke, and a swallowing evaluation is ordered. Which nursing interventions might be recommended to help prevent aspiration during eating? Select all that apply. (Select All that Apply.)

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When taking blood pressure medications, it is important to reinforce education with the patient on which topics? Select all that apply.

The nurse is caring for a patient who presents to the emergency department with right-sided weakness and dysphasia. Which type of stroke would the nurse suspect?