The nurse is developing a plan of care for a client who reports blurred vision and who is newly diagnosed with cardiovascular disease. Which outcome should the nurse include in the plan of care for this client?

The client's blood pressure readings will be less than 160/90 mm Hg.

The nurse will encourage the client to walk thirty minutes every day.

The client's family will repeat signs and symptoms about the disease.

The client's daily blood pressure will be less than 140/80 mm Hg this month.

Answer and Explanation

The Correct Answer is D

A. While controlling blood pressure is important in managing cardiovascular disease, the specific outcome should reflect the target blood pressure goal of less than 140/80 mm Hg to reduce the risk of complications.

B. Encouraging physical activity is beneficial for cardiovascular health, but the outcome should focus on blood pressure management, which is more directly related to the client's reported symptoms of blurred vision.

C. Educating the client's family about signs and symptoms of cardiovascular disease is important for support, but it does not directly address the client's blurred vision or cardiovascular risk factors.

D. Achieving a daily blood pressure reading of less than 140/80 mm Hg is an appropriate outcome to ensure adequate control of blood pressure and reduce the risk of cardiovascular complications, including those that may contribute to blurred vision.

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Correct Answer is D

Explanation

A. Auscultating the abdomen for bowel sound activity is important, but the priority is addressing the dehisced and eviscerated wound.

B. Bringing additional sterile dressing supplies is a good idea, but the priority is addressing the dehisced and eviscerated wound.

C. Obtaining a sample of the drainage for laboratory analysis can wait until the client's immediate needs are addressed.

D. Preparing the client to return to the operating room is the priority to address the dehisced and eviscerated wound and prevent further complications.

A. Assess the pin sites for signs of infection. B. Administer pain medication at designated intervals around the clock. C. Assess the pulses proximal to the fracture site. D. Remove traction every shift and provide skin care.

Correct Answer is A

Explanation

A. Assessing the pin sites for signs of infection is essential in clients with skeletal traction to detect any early signs of infection, such as redness, swelling, warmth, or purulent drainage. Prompt identification and management of pin site infections can prevent complications.

B. Administering pain medication at designated intervals around the clock helps to ensure adequate pain control and comfort for the client. However, this intervention alone does not specifically address the care needs related to skeletal traction.

C. Assessing the pulses proximal to the fracture site is important for monitoring circulation and detecting any signs of impaired perfusion. However, this assessment is not directly related to the care of skeletal traction itself.

D. Removing traction every shift is not indicated unless there is a specific reason to do so as ordered by the healthcare provider. Continuous traction is often necessary for proper alignment and stabilization of the fracture. Additionally, providing skin care is important to prevent skin breakdown around the traction device, but removing traction every shift is not part of routine care.

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The nurse is developing a plan of care for a client who reports blurred vision and who is newly diagnosed with cardiovascular disease. Which outcome should the nurse include in the plan of care for this client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

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Correct Answer is A

Explanation

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