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Which action by the nurse will determine if therapies ordered for a patient with chronic constrictive pericarditis are effective?

Check the electrocardiogram (ECG) for ST segment changes.

Assess for the presence of jugular venous distention (VD).

Monitor for changes in the patient's sedimentation rate.

Assess for the presence of a paradoxical pulse.

Answer and Explanation

The Correct Answer is B

Choice A rationale:

ST segment changes on an ECG are not typically associated with chronic constrictive pericarditis.

Choice B rationale:

Jugular venous distention (JVD) is a common sign of chronic constrictive pericarditis. If JVD is not present, it may indicate that the therapies are effective.

Choice C rationale:

While the sedimentation rate can indicate inflammation, it is not specific to chronic constrictive pericarditis.

Choice D rationale:

The presence of a paradoxical pulse is not typically associated with chronic constrictive pericarditis.

So, the correct answer is B, after analyzing all choices.

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Correct Answer is B

Explanation

Choice A rationale:

Checking the pulse rate before taking nitroglycerin is not necessary.

Choice B rationale:

Sitting down before taking nitroglycerin can prevent dizziness and fainting, which are potential side effects of nitroglycerin.

Choice C rationale:

There is no need to remove the nitroglycerin patch before taking sublingual nitroglycerin.

Choice D rationale:

The nitroglycerin patch should not be used to treat acute chest pain.

So, the correct answer is B, after analyzing all choices.

A. Temperature. B. Oxygen saturation. C. Blood pressure. D. Weight. E. Urine output. F. Breath sounds.

Correct Answer is ["B","C","D","F"]

Explanation

Choice A rationale:

The client’s temperature decreased from 37.6°C to 36.8°C1. This is within the normal body temperature range of 36.5°C to 37.2°C2, so it does not require further action.

Choice B rationale:

The client’s oxygen saturation decreased from 95% to 88%1. Normal pulse oximetry values are typically above 95%2. This decrease could indicate that the client is not getting enough oxygen, which requires further action.

Choice C rationale:

The client’s blood pressure increased from 108/50 mm Hg to 138/80 mm Hg. Normal blood pressure for adults is below 120/80 mm Hg. This increase could indicate worsening heart failure, which requires further action.

Choice D rationale:

The client’s weight increased from 80 kg to 82.1 kg. Rapid weight gain may be a sign of fluid retention, a common symptom of heart failure. This requires further action.

Choice E rationale:

The client’s urine output decreased from 480 mL/8 hr to 320 mL/8 hr.However it is still above 30ml/hr signifying normal renal function

Choice F rationale:

On Day 4, the client’s breath sounds were scattered, and crackles were heard bilaterally. This could indicate fluid accumulation in the lungs, a common symptom of heart failure. This requires further action.

So, the correct answer is Choices B, C, D, and F, after analyzing all choices.

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Which action by the nurse will determine if therapies ordered for a patient with chronic constrictive pericarditis are effective?

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Naxlex Comprehensive Predictor Exams

In preparation for discharge, the nurse teaches a patient with chronic stable angina how to use the prescribed short-acting and long-acting nitrates. Which patient statement indicates that the teaching has been effective?.

Correct Answer is B

Explanation

Correct Answer is ["B","C","D","F"]

Explanation

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