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A client with history of atrial fibrillation is admitted to the
telemetry unit with sudden onset of shortness of breath.
The nurse observes a new irregular heart rhythm and
should perform which assessment at this time?
Check for a pulse deficit.
Palpate the apical impulse.
Inspect jugular vein pulse.
Examine for a carotid bruit. - Answers-Check for a pulse
deficit.
A client with a past history of atrial fibrillation may return to
that rhythm. Any signs of atrial fibrillation, such as sudden
onset shortness of breath, requires further investigation.
The nurse should assess this client for a pulse deficit
because this condition occurs with atrial fibrillation.
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Which client should be further assessed for an ectopic
pregnancy?
A 24-year-old with shoulder and lower abdominal quadrant
pain.
A 33-year-old with intermittent lower abdominal cramping.
A 20-year-old with fever and right lower abdominal colic.
A 40-year-old with jaundice and right lower abdominal
pain. - Answers-A 24-year-old with shoulder and lower
abdominal quadrant pain.
A 24-year-old with sudden onset of lower abdominal
quadrant pain should be assessed for an ectopic
pregnancy. The pain can also be referred to the shoulder
and may be associated with vaginal bleeding.
Which dietary assessment finding is most important for the
nurse to address when caring for a client with diabetic
nephropathy?
Drinks a six pack of beer every day.
Enjoys a hamburger once a month.
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Eats fortified breakfast cereal daily.
Consumes beans and rice every day. - Answers-Drinks a
six pack of beer every day.
Drinking six beers every day is the dietary assessment
finding most important for the nurse to address when
caring for a client with diabetic nephropathy. The usual can
of beer is 12 ounces (355 mL). Clients with diabetes are
recommended to drink no more than 12 ounces of beer
per day because beer contains carbohydrates that can
create unhealthy fluctuations in blood glucose and
promote poor glucose control. Nephropathy is
exacerbated by poor blood glucose control.
Which assessment finding is of greatest concern to the
nurse who is caring for a client with stomatitis?
Cough brought on by swallowing.
Sore throat caused by speaking.
Painful and dry oral cavity.
Unintended weight loss. - Answers-Cough brought on by
swallowing.
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A cough brought on by swallowing is a sign of dysphagia,
which is a finding of particular concern in a client with
stomatitis. Dysphagia can cause numerous problems,
including airway obstruction, and should be reported to the
healthcare provider immediately.
The nurse is teaching a client diagnosed with peripheral
arterial disease. Which genitourinary system complication
should the nurse include in the teaching?
Altered sexual response.
Sterility.
Urinary incontinence.
Decreased pelvic muscle tone. - Answers-Altered sexual
response.
Peripheral arterial disease (PAD) is a cardiovascular
condition characterized by narrowing of the arteries and
reduced blood flow to the extremities. PAD is known to
alter the blood flow to the male's penis and is associated
with erectile dysfunction in men.