A client with a history of heart failure and hypertension is in the clinic for a follow-up visit.
The client is on lisinopril and warfarin.
The client reports a new-onset cough.
What action by the nurse is most appropriate?
Assess the client's lung sounds and oxygenation.
Instruct the client on another antihypertensive.
Obtain a set of vital signs and document them.
Remind the client that a cough is a side effect of lisinopril.
The Correct Answer is A
Choice A rationale
While a cough is a known side effect of lisinopril due to bradykinin accumulation, a new-onset cough in a client with heart failure and hypertension could also signal worsening heart failure, particularly pulmonary edema. Assessing lung sounds for crackles and monitoring oxygenation is paramount to differentiate between these two distinct etiologies and guide appropriate intervention.
Choice B rationale
Changing antihypertensives is a medical decision made by the provider. The nurse's role is to assess the client's symptoms and provide objective data to the provider. Switching medications without a thorough assessment could be premature and might delay the diagnosis of a more serious condition like decompensated heart failure.
Choice C rationale
Obtaining vital signs is a fundamental nursing action, but it is not the most appropriate initial action in this specific clinical scenario. The report of a new cough in a client with heart failure necessitates a targeted assessment of the respiratory system, including auscultating lung sounds and evaluating for signs of hypoxemia, to rule out a life-threatening complication.
Choice D rationale
While a cough is a known side effect of lisinopril, dismissing the symptom could be dangerous. The cough may not be benign; it could be an early sign of pulmonary congestion from heart failure. The nurse must perform a comprehensive assessment to ensure the client's safety and to avoid misattributing a serious finding to a common medication side effect.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Applying topical medications in a circular motion can cause friction and irritate the compromised skin barrier in eczema. The goal of treatment is to protect the skin and reduce inflammation. Instead, a gentle, downward stroking motion in the direction of hair growth is recommended to avoid folliculitis and further skin damage.
Choice B rationale
Using a gloved hand during the application of topical treatments for a child with eczema prevents the transfer of microorganisms from the nurse's hands to the child's vulnerable skin, reducing the risk of secondary infection. It also protects the nurse from potential absorption of the medication, particularly if it's a steroid, through their own skin.
Choice C rationale
The frequent and liberal application of topical medications can lead to systemic absorption, especially with corticosteroids, due to the child's higher body surface area to weight ratio and thinner skin. This can cause adverse effects such as adrenal suppression and Cushing's syndrome. Medication application should strictly follow the prescribed dosage and frequency.
Choice D rationale
Lanolin is a common allergen and can exacerbate eczema symptoms in some individuals. It's an ingredient derived from sheep's wool and can trigger contact dermatitis in sensitive individuals. Therefore, lanolin-based ointments are not a universally recommended choice for eczema treatment and should be used with caution.
Correct Answer is A
Explanation
Choice A rationale
African Americans have a disproportionately high prevalence and severity of hypertension compared to other racial groups. This is due to a complex interplay of genetic predispositions, socioeconomic factors, and systemic health disparities. Targeting this community through culturally competent outreach at churches is highly effective.
Choice B rationale
While some Asian populations have a genetic predisposition to certain health conditions, hypertension prevalence is not as markedly high in this group as in African Americans. Community outreach for hypertension screening should focus on populations with the highest risk to maximize public health impact.
Choice C rationale
High school sports camps primarily target a young, generally healthy population. While health education is always valuable, the prevalence of hypertension is much lower in this demographic than in older adult populations. Screening resources would be better allocated to older, higher-risk groups.
Choice D rationale
Women's health clinics serve a broad population, but hypertension affects both genders. While important, this venue does not specifically target the population with the highest prevalence and risk, which data indicates are African-American communities, especially older adults.
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