A client one (1) day postoperative for coronary artery bypass graft (CABG) reports chest pain.
Which intervention should the nurse implement first?

Notify the healthcare provider.

Assess the client's vital signs and check the telemetry monitor.

Encourage the client to take deep breaths.

Administer pain medication immediately.

Answer and Explanation

The Correct Answer is B

Choice A rationale

Notifying the healthcare provider is necessary, but assessing the client's condition comes first to provide relevant information.

Choice B rationale

Assessing the client's vital signs and telemetry monitor is the first step to determine the cause of chest pain and ensure it is not due to a life-threatening issue such as myocardial infarction.

Choice C rationale

Encouraging the client to take deep breaths can be helpful but is not the first priority. It addresses pain related to breathing but not the underlying cause.

Choice D rationale

Administering pain medication is important, but only after determining the cause of the chest pain and ruling out serious complications.

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Correct Answer is A

Explanation

Choice A rationale

A decreased white blood cell count indicates the body's response to infection is improving, showing the effectiveness of the antibiotics.

Choice B rationale

Increased chest pain and shortness of breath would suggest worsening of the condition, not improvement.

Choice C rationale

Adventitious breath sounds and increased cough are signs that pneumonia may be persisting or worsening.

Choice D rationale

Improved appetite and weight gain are positive signs but are not direct indicators of the effectiveness of antibiotic treatment.

A. I will lie down for one half hour after meals. B. I will sleep with the head of my bed elevated. C. I will consume less caffeine and fewer spicy foods. D. I will try not to gain weight. E. I will drink less fluid.

Correct Answer is ["B","C","D"]

Explanation

Choice A rationale

Lying down after meals can increase the risk of acid reflux in individuals with a hiatal hernia. Patients are often advised to remain upright after eating to minimize symptoms.

Choice B rationale

Elevating the head of the bed helps prevent gastric contents from refluxing into the esophagus, reducing symptoms of hiatal hernia and promoting better sleep.

Choice C rationale

Reducing caffeine and spicy foods can help manage symptoms, as these substances can irritate the stomach lining and exacerbate reflux in hiatal hernia patients.

Choice D rationale

Maintaining a healthy weight is important because excess weight can increase abdominal pressure and contribute to the worsening of hiatal hernia symptoms.

Choice E rationale

Drinking less fluid is not typically a recommendation for hiatal hernia. Adequate hydration is important for overall health, and reducing fluid intake may not have a significant impact on symptoms.

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A client one (1) day postoperative for coronary artery bypass graft (CABG) reports chest pain.Which intervention should the nurse implement first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A patient with right lower-lobe pneumonia has been treated with intravenous antibiotics for 3 days.Which assessment data obtained by the nurse indicates that the treatment is effective?

Correct Answer is A

Explanation

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Correct Answer is ["B","C","D"]

Explanation

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A client one (1) day postoperative for coronary artery bypass graft (CABG) reports chest pain.
Which intervention should the nurse implement first?