A client reports episodes of syncope. Which assessment finding should the nurse anticipate?
Decreased BP during orthostatic blood pressure measurement.
Grade 3 systolic murmur auscultated at the pulmonic site.
3+ carotid pulse volume bilaterally.
Positive jugular vein distention (JVD) bilaterally.
The Correct Answer is A
A. Decreased BP during orthostatic blood pressure measurement: Syncope (fainting) often results from decreased blood flow to the brain. Orthostatic hypotension (a drop in blood pressure upon standing) can lead to syncope.
B. Grade 3 systolic murmur auscultated at the pulmonic site: A systolic murmur may indicate valvular or cardiac issues but is not directly related to syncope.
C. 3+ carotid pulse volume bilaterally: Carotid pulse volume assessment helps evaluate blood flow to the brain. Normal carotid pulses are important for preventing syncope
D. Positive jugular vein distention (JVD) bilaterally: JVD is associated with heart failure or fluid overload. While it may not directly cause syncope, it can contribute to overall cardiovascular instability.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["9"]
Explanation
To determine the Apgar score for the newborn infant, we assess five parameters: heart rate, respiratory effort, muscle tone, reflex irritability, and color. Each parameter is scored from 0 to 2, with 2 being the highest score. Let's evaluate each parameter:
- Heart rate: 150 beats/minute --> Score of 2.
- Respiratory effort: Vigorous cry present --> Score of 2.
- Muscle tone: Good muscle tone with total flexion --> Score of 2.
- Reflex irritability: Quick reflex irritability noted --> Score of 2.
- Color: Dusky and cyanotic skin color --> Score of 1.
Now, we sum up the scores: 2+2+2+2+1=92+2+2+2+1=9
Therefore, the Apgar score for this infant is 9.
Correct Answer is A
Explanation
A. Decreased height: Osteoporosis often leads to vertebral fractures, especially in the upper (thoracic) spine. These fractures can cause pain, height loss, and a stooped or hunched posture (kyphosis).
B. Loss of appetite: While osteoporosis itself does not directly cause loss of appetite, it’s essential to assess overall health and nutritional status. However, this symptom is not directly related to kyphosis.
C. Weight gain: Weight gain is not typically associated with osteoporosis or kyphosis. It is less relevant in this context.
D. Painful swallowing: Painful swallowing is not directly related to osteoporosis or kyphosis. It is less relevant in this context.
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