The student nurse is reviewing different types of health history. Which client situation would require an Emergency health history?
A client who has recently been diagnosed with a chronic illness.
A client with hypotension, tachycardia, SpO2 85%, and a recent gunshot wound.
A client who just confirmed she is pregnant.
A client who makes frequent hospital visits reporting the same symptom.
The Correct Answer is B
Choice a reason:
A client recently diagnosed with a chronic illness would require a comprehensive health history that includes past medical history, medications, and lifestyle factors. While important, it is not typically categorized as an emergency health history unless the chronic condition has acutely worsened.
Choice b reason:
A client presenting with hypotension (low blood pressure), tachycardia (rapid heart rate), an oxygen saturation of 85% (indicating potential hypoxemia), and a recent gunshot wound is experiencing a life-threatening situation that requires immediate medical attention. An Emergency health history is crucial in this scenario to quickly gather information that will guide urgent treatment decisions.
Choice c reason:
A client who has just confirmed pregnancy would need a detailed health history, including obstetric and gynecological history, but this is not considered an emergency unless there are complications or concerns that require immediate attention.
Choice d reason:
A client who frequently visits the hospital reporting the same symptom may indicate a chronic issue that needs ongoing management rather than an emergency. However, if the symptom suggests an acute exacerbation or a new, serious condition, it could escalate to an emergency.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice a reason:
Exophthalmos, or protrusion of the eyeballs, is not a typical finding in hypothyroidism. It is more commonly associated with hyperthyroidism, particularly Graves' disease, which is characterized by an overactive thyroid gland.
Choice b reason:
Photophobia, or light sensitivity, is not a common symptom of hypothyroidism. While it can be associated with other conditions, it is not directly related to the function of the thyroid gland.
Choice c reason:
Weight loss is typically not associated with hypothyroidism. In fact, individuals with hypothyroidism often experience weight gain due to a slowed metabolism, which is the opposite of weight loss.
Choice d reason:
Lethargy is a common symptom of hypothyroidism. The condition can lead to a decrease in thyroid hormone production, which can slow down the body's metabolism, resulting in feelings of fatigue, sluggishness, and lethargy.
Correct Answer is ["A","C","D"]
Explanation
Choice a reason:
Obtaining and checking the needed equipment is essential before conducting a physical examination. This ensures that all necessary tools are functional and readily available, which facilitates a smooth and efficient assessment process. It also minimizes interruptions that could cause discomfort or anxiety for the client.
Choice b reason:
While turning on relaxing music of the client's choice may create a calming environment, it is not a standard procedure before a physical examination. Music preferences are subjective, and what is relaxing for one person may be distracting for another. Additionally, music could interfere with the ability to hear heart, lung, or bowel sounds during auscultation.
Choice c reason:
Identifying ways to ensure client privacy is a fundamental nursing responsibility. It respects the client's dignity and promotes a sense of safety and comfort. Privacy can be ensured by closing curtains, securing the area, and making sure the examination is conducted in a private setting.
Choice d reason:
Washing hands is a critical step before any physical examination. It is a primary measure for infection control, protecting both the nurse and the client from potential transmission of microorganisms.
Choice e reason:
Dimming the lighting to promote comfort is not typically recommended before a physical examination. Adequate lighting is crucial for the inspection phase of the examination, allowing the nurse to observe the client's general appearance, skin color, and other physical characteristics accurately.
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