Nursing a Concept Based Approach Test Bank

Questions 14

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Nursing a Concept Based Approach Test Bank Questions

Question 1 of 5

The nurse is caring for a client diagnosed with dilated cardiomyopathy. Which clinical manifestations does the nurse anticipate during the physical assessment? Select all that apply.

Correct Answer: A

Rationale: Dilated cardiomyopathy is a condition characterized by an enlarged and weakened heart muscle, leading to decreased heart function. Common clinical manifestations of dilated cardiomyopathy include:

Question 2 of 5

A nurse working on an antepartum unit is providing care for a client with preeclampsia. Which laboratory value does the nurse anticipate for this client?

Correct Answer: D

Rationale: In a client with preeclampsia, one of the laboratory values that the nurse might anticipate is an increased serum creatinine level. Preeclampsia is a hypertensive disorder of pregnancy characterized by high blood pressure and involvement of multiple organ systems, including the kidneys. An elevated serum creatinine level indicates impaired kidney function, as creatinine is a waste product that is normally filtered by the kidneys and excreted in the urine. In preeclampsia, reduced kidney perfusion due to the high blood pressure can lead to decreased glomerular filtration rate, resulting in elevated serum creatinine levels. Monitoring serum creatinine is essential in assessing kidney function and guiding management in clients with preeclampsia.

Question 3 of 5

The nurse is assessing a toddler diagnosed with tetralogy of Fallot (TOF). Which clinical manifestations does the nurse anticipate during the physical assessment? Select all that apply.

Correct Answer: A

Rationale: 1. A palpable thrill in the pulmonic area is a common finding in children with tetralogy of Fallot (TOF). This sensation is caused by turbulent blood flow across the pulmonic valve due to the structural abnormalities present in TOF.

Question 4 of 5

The nurse is caring for a client who develops dyspnea and chest pain. Which diagnostic finding is consistent with a pulmonary embolism (PE)?

Correct Answer: D

Rationale: Tachycardia and nonspecific T-wave changes on the EKG are consistent with a pulmonary embolism (PE). Tachycardia is a common finding in PE, as the body tries to compensate for the decreased oxygenation due to the blockage in the pulmonary artery. Nonspecific T-wave changes, such as ST-segment abnormalities or inverted T-waves, can also be seen in patients with PE. These EKG findings, along with symptoms like dyspnea and chest pain, raise the suspicion for pulmonary embolism and warrant further diagnostic workup. Options A, B, and C are not specific findings related to a pulmonary embolism.

Question 5 of 5

The nurse is planning care for an older adult client with chronic venous insufficiency. Which will the nurse include in the client's teaching plan?

Correct Answer: B

Rationale: Elastic compression therapy, such as wearing elastic hose (compression stockings), is an essential component of managing chronic venous insufficiency. Compression stockings help improve venous return, reduce edema, and alleviate symptoms such as pain and swelling. They work by applying external pressure to the legs, promoting better circulation and preventing blood from pooling in the veins. The nurse should ensure that the client wears the compression stockings as prescribed to maximize their effectiveness in managing the condition.

Similar Questions

The nurse is planning care for an older adult client with chronic venous insufficiency. Which will the nurse include in the client's teaching plan?
The nurse is assessing a patient�s deep tendon reflexes. For which endocrine disorder is this nurse assessing?
The nurse is caring for a client diagnosed with dilated cardiomyopathy. Which clinical manifestations does the nurse anticipate during the physical assessment? Select all that apply.
A client diagnosed with disseminated intravascular coagulation (DIC) is currently bleeding through the gastrointestinal tract. Which does the nurse anticipate administering to this client as a first line treatment?
A nurse is caring for a child who is hospitalized for an exacerbation of asthma. The nurse is preparing discharge teaching, as the client will be going home on nebulizer treatments and an inhaler. The client and her family members, who are recent immigrants to the United States, speak little English. In addition to enlisting an interpreter to help with the language barrier, what should be a priority for the nurse in developing a teaching plan?

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