Perfusion
intermittent claudication
An older client tells the nurse, "My legs begin to hurt after walking my dog for several blocks. The pain goes away when I stop walking, but it comes back again when I resume walking." Which condition does the nurse consider as the most likely cause of the client's pain?
On the morning of surgery a client is admitted for resection of an abdominal aortic aneurysm. While awaiting surgery, the client suddenly develops symptoms of shock. Which nursing action is priority?
notify the surgeon immediately
A client is admitted to the hospital with a long history of hypertension. The nurse should assess the client for which complication?
Kidney failure
An older client who has had multiple hospital admissions for recurring heart failure is returned to the hospital by an adult child. The client is admitted for observation to the coronary care unit and calmly states, "I know I'm sick, but I can really take care of myself at home." What should the nurse conclude that the client most likely attempting to do?
Maintain independence
A 3-year-old child is scheduled for cardiac catheterization. What is the priority nursing care after this procedure?
Monitor the site for bleeding
A 4-year old child is undergoing a diagnostic workup for pulmonic stenosis. The mother ask the nurse about the diagnosis. How does the nurse describe pulmonic stenosis?
Narrowing of the valve between the right ventricle and pulmonary artery
A nurse is assessing a client's ECG reading. The client's atrial and ventricular heart rates are equal at 88 bpm. The PR interval is 0.14s, and the QRS width is 0.10s. Rhythm is regular with normal P waves and QRS complexes. How will the nurse interpret this rhythm?
Normal sinus rhythm
Numbness
A nurse is assessing a client with a cast to the extremity. Which assessment find is priority?
A nurse is providing discharge instructions to a client who experienced an anterior septal myocardial infarction. Which statement by the client indicates the nurse needs to follow up?
"I am not good at remembering to take medication"
What is the normal value of the inspiratory reserve volume?
3.0 L
Tachycardia and petechiae over the chest
A client has an open reduction and internal fixation (ORIF) of a fractured hip. The nurse monitors this client for signs and symptoms of a fat embolism. Which client assessment finding reflects this complication?
Check for a pulse
A client is on a cardiac monitor. The monitor begins to alarm showing ventricular tachycardia.What should the nurse do first?
Consume a high-fiber diet and drink adequate water
A client tells the nurse about recent recurrent episodes of bleeding hemorrhoids. What should the nurse advise the client to do to help prevent future hemorrhoidal episodes?
To increase oxygen concentration to heart cells
A client with a coronary occlusion is experiencing chest pain and distress. Why does the nurse administer oxygen?
What is the minimum heart rate of a 14-year-old? Record your answer in whole number.
60 beats per minute
Impaired portal venous return
A client with a long history of alcohol abuse develops cirrhosis of the liver. The client exhibits the presence of ascites. What does the nurse conclude is the most likely cause of this client's ascites?
Check pulses is legs regularly
A client with arterial insufficiency of both lower extremities is visited by the home healthcare nurse. What client teaching is an essential nursing intervention?
Slows and strengthens cardiac contraction
A client with heart failure is to receive digoxin and ask the nurse why the medication is necessary. What physiologic response will the nurse include when answering the client's question?
Coolness
A nurse assesses a clients IV site. What clinical finding, unique to infiltration, leads the nurse to conclude that the IV site has infiltrated, rather than become inflamed?
Perform neurovascular assessment every 2 hours
A client with impaired peripheral pulses and signs of chronic hypoxia in a lower extremity is scheduled for a femoral angiogram. What would be appropriate for the nurse to include in postprocedure plan of care.
Periorbital edema, smoky urine, headaches
A 5-year-old is admitted to the pediatric unit with a diagnosis of acute poststreptococcal glomerulonephritis. What assessment data lead the nurse to conclude that the child has fluid volume excess?
A client is diagnosed with hepatitis A. The nurse provided he client with information about untoward signs and symptoms related to hepatitis. The nurse instructs the client to contact the primary healthcare provider if clients develops what symptoms?
Clay-colored stools
The nurse is assessing the integumentary system of four clients. Which client has the least chance of a false-positive result while undergoing assessment of capillary refill time?
Client with epilepsy
What are the primary causes of adrenal insufficiency? Select all that apply
Hemorrhage, tuberculosis, acquired immune deficiency syndrome
what are the cardiovascular manifestation observed in a client with adrenal insufficiency?
Hyponatremia
A client sustains a fractured right femur after an automobile accident and is admitted to the hospital's ED. Which assessment is priority?
Take the client's pedal pulse in the affected extremity
110/65 mm Hg
What is the optimal blood pressure of an adolescent?
Prevention of increased respiratory effort to promote oxygenation
What should a nursing care of an 8-month-old infant with tetralogy of Fallot include?
Assess the client's heart and lung sounds
When an older client with heart failure is transferred from the ED to the medical service, what should the nurse on the unit do first?
Rheumatic fever
Which disease condition associated with the client's heart is an example of an autoimmune disease?
