You are providing care to a patient with pericarditis.
Which of the following is NOT a proper nursing intervention for this patient?
Administer Ibuprofen as scheduled.
Monitor the patient for complications of cardiac tamponade.
Place the patient in a supine position to relieve pain.
Monitor the patient for pulsus paradoxus and muffled heart sounds.
The Correct Answer is C
Choice A rationale
Administering Ibuprofen as scheduled is a proper nursing intervention for a patient with pericarditis. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can help reduce inflammation and relieve pain.
Choice B rationale
Monitoring the patient for complications of cardiac tamponade is a proper nursing intervention for a patient with pericarditis. Cardiac tamponade is a serious condition that can occur as a complication of pericarditis.
Choice C rationale
Placing the patient in a supine position to relieve pain is not a proper nursing intervention for a patient with pericarditis. This position could actually increase the patient’s discomfort.
Instead, the patient should be positioned upright and leaning forward to help relieve pain.
Choice D rationale
Monitoring the patient for pulsus paradoxus and muffled heart sounds is a proper nursing intervention for a patient with pericarditis. These are potential signs of worsening pericarditis or complications such as cardiac tamponade.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Stable angina is characterized by chest pain that occurs with exertion and is relieved by rest. If a patient with angina pectoris is experiencing chest pain at rest and needs to take three nitroglycerin pills to relieve the pain, this is not typical of stable angina.
Choice B rationale
A full-blown acute myocardial infarction (MI), or heart attack, typically presents with severe chest pain, shortness of breath, and other symptoms. While chest pain at rest could be a symptom of an MI, other symptoms would likely be present.
Choice C rationale
Unstable angina is characterized by chest pain that occurs at rest, is severe and prolonged, and is not relieved by nitroglycerin. Therefore, a patient with angina pectoris who is experiencing chest pain at rest and needs to take three nitroglycerin pills to relieve the pain could be experiencing unstable angina.
Choice D rationale
Pulmonary embolus, a blockage in one of the pulmonary arteries in the lungs, typically presents with sudden-onset shortness of breath, chest pain that may become worse upon deep breathing or coughing, and other symptoms. Chest pain at rest could be a symptom of a pulmonary embolus, but other symptoms would likely be present.
Correct Answer is ["A","B","C","D"]
Explanation
Choice A rationale
A 65-year-old male recovering from right lobectomy for treatment of lung cancer is at risk for developing sepsis. Post-surgical patients, especially those with cancer, are at increased risk due to potential infection at the surgical site and a weakened immune system from the cancer and/or its treatment.
Choice B rationale
A 78-year-old female with diabetes mellitus who is recovering from colon surgery is at risk for developing sepsis. Diabetes can impair the immune system, making it harder for the body to fight off infections. Additionally, any surgical procedure carries a risk of infection.
Choice C rationale
A 35-year-old female who is hospitalized with renal insufficiency and has a Foley catheter and central line in place is at risk for developing sepsis. Hospitalized patients, particularly those with invasive devices like catheters and central lines, are at increased risk due to potential introduction of bacteria into the body.
Choice D rationale
A 55-year-old male who is a recent kidney transplant recipient is at risk for developing sepsis. Transplant recipients are often on immunosuppressive therapy to prevent organ rejection, which can leave them more susceptible to infections.
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