The nurse receives information about the assigned patients during shift report.
Which patient would the nurse assess first?

A patient who reports dizziness with a blood pressure (BP) of 150/92 mm Hg.

A patient who reports a severe headache and has begun vomiting.

A patient with a hip fracture who reports a pain level of 2 on a 1-to-10 scale.

A patient who received an angiotensin-converting enzyme (ACE) inhibitor 30 minutes previously and reports fatigue.

Answer and Explanation

The Correct Answer is B

Choice A rationale:

Dizziness with a blood pressure of 150/92 mm Hg indicates hypertension, but it is not an immediate life-threatening condition requiring urgent assessment compared to a severe headache and vomiting.

Choice B rationale:

A severe headache and vomiting could be indicative of a serious neurological condition such as a stroke, intracranial bleeding, or increased intracranial pressure. This patient needs urgent assessment and intervention to prevent potential complications.

Choice C rationale:

A hip fracture with a pain level of 2 on a 1-to-10 scale suggests pain but is not immediately life-threatening compared to symptoms like severe headache and vomiting.

Choice D rationale:

Fatigue after receiving an ACE inhibitor is a common side effect and, while important to monitor, does not pose an immediate threat compared to the symptoms of severe headache and vomiting.

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Correct Answer is C

Explanation

Choice A rationale:

While leukemia treatment does have severe side effects, not all of them are permanent. It is essential for the patient to be aware of potential complications but also to understand that some side effects might be temporary and can be managed with appropriate care.

Choice B rationale:

Using the call light to ask for help when getting out of bed is essential for patients receiving chemotherapy, as their immune system might be compromised, making them prone to infections and injuries. However, this information is not specific to leukemia treatment but is a general safety measure for these patients.

Choice C rationale:

Patients undergoing chemotherapy for leukemia are at an increased risk of infections due to the suppression of the immune system. Preventive measures, such as good hygiene practices and early detection of signs of infection, are crucial in managing these patients. Educating the patient about infection prevention is essential for their safety during treatment.

Choice D rationale:

Feeling isolated can be a common emotional response to any chronic illness, including leukemia. However, it is not an unavoidable consequence, and providing emotional support and involving the patient in support groups can help mitigate these feelings. This statement does not provide essential information about managing leukemia treatment.

A. Occurs with both activity and rest. B. Generally lasts 10-15 minutes or more. C. Does not subside when the precipitating factor is resolved. D. Occurs intermittently over a period of time in a similar pattern.

Correct Answer is D

Explanation

Choice A rationale:

Chronic stable angina typically occurs with activity and is relieved with rest or nitroglycerin. Therefore, this statement is incorrect for chronic stable angina.

Choice B rationale:

Chronic stable angina usually lasts for a short duration, usually around 5 minutes, and is relieved with rest or nitroglycerin. Prolonged pain lasting 10-15 minutes or more could indicate an unstable angina or myocardial infarction. This choice is incorrect for chronic stable angina.

Choice C rationale:

Pain due to chronic stable angina subsides when the precipitating factor, such as physical exertion, is resolved or with medication like nitroglycerin. Therefore, this statement is incorrect for chronic stable angina.

Choice D rationale:

Chronic stable angina follows a predictable pattern, occurring intermittently over a period of time, and is usually triggered by physical exertion or emotional stress. This option correctly describes the characteristic pattern of chronic stable angina.

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The nurse receives information about the assigned patients during shift report.Which patient would the nurse assess first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which information will the nurse include when teaching a patient who is receiving chemotherapy for leukemia?

Correct Answer is C

Explanation

Which information would the nurse include when discussing pain due to chronic stable angina with the patient?

Correct Answer is D

Explanation

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The nurse is teaching a patient about the administration of liquid iron supplements. Which response by the patient indicates the need for additional teaching?

The nurse receives information about the assigned patients during shift report.Which patient would the nurse assess first?

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Which rationale supports the nurse's assessment of a patient's magnesium level?

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Which phrase describes the function of a buffer?

A patient reports leg pain that awakens the patient at night.The patient reports that the same pain develops in the legs when they are elevated and disappears when the legs are dangled.Which condition would the nurse suspect?

The nurse receives information about the assigned patients during shift report.
Which patient would the nurse assess first?