A 40-year-old patient is admitted with sharp, pleuritic chest pain and dyspnea. The nurse observes jugular venous distension and muffled heart sounds on examination. What is the most appropriate initial nursing action for this patient?

Encouraging the patient to take deep breaths and cough

Administering oxygen to maintain adequate oxygenation

Positioning the patient flat in bed to decrease discomfort

Providing the patient with a warm compress to relieve chest pain

Positive Tinel's sign

Answer and Explanation

The Correct Answer is B

A.   Encouraging the patient to take deep breaths and cough would not address the underlying cause of the symptoms, which may indicate a more serious condition.
B.   Administering oxygen to maintain adequate oxygenation is the most appropriate initial action, as the patient’s symptoms suggest a potentially life-threatening condition like a cardiac tamponade or pulmonary embolism.
C.   Positioning the patient flat in bed is not recommended, as it may exacerbate breathing difficulties and
the patient’s distress.
D.   A warm compress is unlikely to be beneficial in this acute situation and could delay appropriate intervention.

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Correct Answer is B

Explanation

A. Aspirin can irritate the gastrointestinal lining, making it unsuitable for patients with GERD.
B. Alcohol and caffeine both relax the lower esophageal sphincter, which can increase the risk of acid reflux and worsen GERD symptoms.
C. Lying down immediately after eating can increase the likelihood of acid reflux and exacerbate GERD symptoms.
D. While mercury-containing seafood can be harmful in other contexts, it is not directly linked to GERD and should not be a primary concern.

A. Elevated ketones in the urine B. Presence of nitrites in the urine C. Low specific gravity D. Presence of glucose in the urine

Correct Answer is B

Explanation

A. Elevated ketones in the urine can indicate diabetic ketoacidosis or starvation but is not specific to a UTI.
B. Nitrites are commonly found in the urine of patients with UTIs due to bacterial conversion of urinary nitrates to nitrites. This is a hallmark finding of a UTI.
C. Low specific gravity indicates diluted urine, which is not a direct indicator of a UTI.
D. Glucose in the urine could indicate diabetes but is not a typical finding for a UTI.

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A 40-year-old patient is admitted with sharp, pleuritic chest pain and dyspnea. The nurse observes jugular venous distension and muffled heart sounds on examination. What is the most appropriate initial nursing action for this patient?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is educating a client about the risk factors for GERD (gastroesophageal reflux disease). Which of the following statements should the nurse include?

Correct Answer is B

Explanation

A 30-year-old female patient presents with symptoms of dysuria, urgency, and frequency. A urinalysis is performed. Which of the following findings would most likely confirm a diagnosis of a urinary tract infection (UTI)?

Correct Answer is B

Explanation

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