A nurse in the emergency department is assessing a client who has a history of angina and reports chest pain. Which of the following findings is the priority?

Three doses of nitroglycerin relieve the client's pain.

Pain radiates to the client's left arm.

Pain began in the morning while the client was resting.

Pain is greatest in the client's substernal chest area.

Answer and Explanation

The Correct Answer is C

Rationale:

A. Three doses of nitroglycerin relieve the client's pain: While nitroglycerin can relieve chest pain related to angina, the fact that the pain subsides after three doses may indicate stable angina. However, this does not address the underlying concern if the pain began at rest, which is more concerning.

B. Pain radiates to the client's left arm: Pain radiating to the left arm is a common symptom of angina or myocardial infarction (MI). While this is concerning, it is not the most urgent finding compared to the pain onset, especially when pain occurs at rest.

C. Pain began in the morning while the client was resting: Chest pain occurring at rest, especially in the morning, is the most concerning symptom. This could indicate unstable angina or an impending myocardial infarction (MI). Unstable angina is more dangerous than stable angina and requires immediate intervention.

D. Pain is greatest in the client's substernal chest area: Substernal chest pain is characteristic of angina, but it is not as concerning as the timing of pain onset. Pain at rest, especially in the morning, suggests unstable angina or MI, which is a higher priority.

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Correct Answer is B

Explanation

Rationale:

A. Pursue local protective services: While protective services can be considered if there are signs of abuse or neglect, this is not the immediate recommendation in this situation. The caregiver's fatigue and irritability indicate stress, not abuse, other support options should be explored first.

B. Consider respite care services: Respite care provides temporary relief for caregivers, allowing them to rest and recharge. This is the most appropriate recommendation for a caregiver experiencing stress, as it helps prevent burnout and promotes better care for the client.

C. Take a nonprescription sleeping medication: While the caregiver may need better rest, self-medicating with nonprescription sleeping medication is not the best approach. It is more important to address the underlying cause of the caregiver’s stress and fatigue through proper support and respite services.

D. Contact hospice services for end-of-life care: Hospice services are for end-of-life care, typically for clients in the final stages of a terminal illness. Alzheimer's disease may lead to progressive decline, but this recommendation is premature.

Correct Answer is []

Explanation

Rationale for Correct Choices:

Upper GI bleed: The client’s symptoms, "coffee ground" emesis, red emesis, dizziness, and weakness, point to an upper gastrointestinal (GI) bleed. The "coffee ground" emesis indicates partially digested blood, a typical finding in upper GI bleeds like peptic ulcers or gastritis.
Place an NG tube and attach it to low suction: An NG tube with low suction helps to clear the stomach of blood and fluid, preventing aspiration and assisting in the management of the upper GI bleed.
Test stools for occult blood: Occult blood testing of stools is essential to confirm gastrointestinal bleeding and assess the extent of the bleed. This is important in making further treatment decisions, including the need for blood transfusions or surgical intervention.
Hemoglobin & haematocrit: Monitoring hemoglobin and hematocrit is critical in assessing the extent of blood loss and the development of anemia, which is common in cases of GI bleeding. This will help determine the need for blood products.
Blood pressure: The client’s blood pressure (89/52 mmHg) indicates possible hypovolemia, a common consequence of GI bleeding. Close monitoring is essential to detect signs of shock or instability, guiding fluid resuscitation and further interventions.

Rationale for Incorrect Choices:

Instruct client to keep a food diary: While useful in managing digestive conditions like irritable bowel syndrome, a food diary is not relevant to managing or diagnosing an acute upper GI bleed.
Recommend tepid sitz baths: Sitz baths are used for conditions like hemorrhoids or anal fissures but are not appropriate for managing an upper GI bleed.
Initiate enteral feeding: Enteral feeding is not indicated in the acute phase of an upper GI bleed. The priority is to stabilize the patient and manage the bleeding before considering nutritional support.
Irritable bowel syndrome: The client’s symptoms, including the coffee-ground emesis and red emesis, are more suggestive of an upper GI bleed than irritable bowel syndrome, which typically causes abdominal pain, diarrhea, and bloating.
Pancreatitis: Pancreatitis typically presents with severe epigastric pain radiating to the back, often associated with nausea and vomiting. While the client has nausea and vomiting, the bloody emesis ("coffee grounds," red emesis) is not a primary symptom of pancreatitis.
Hemorrhoids: Hemorrhoids generally cause rectal bleeding, not upper GI bleeding, and are unlikely to explain the "coffee-ground" or red emesis observed in this client.
Frequently recurring symptoms: This parameter is more relevant to chronic conditions rather than acute bleeding. The focus should be on stabilizing the client and assessing for immediate complications, rather than tracking recurring symptoms.
Left lower quadrant abdominal pain: Left lower quadrant pain is more indicative of other lower GI issues, but it is not directly relevant to diagnosing or managing an upper GI bleed, where pain is more commonly described as epigastric or flank pain.
Amylase and lipase levels: Amylase and lipase are used to assess pancreatic conditions like pancreatitis. They are not useful in diagnosing or monitoring an upper GI bleed, which involves blood loss from the stomach or duodenum, not pancreatic involvement.

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A nurse in the emergency department is assessing a client who has a history of angina and reports chest pain. Which of the following findings is the priority?

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has moderate Alzheimer's disease. During weekly home visits, the nurse notices that the client's caregiver is tired, irritable, and impatient with the client. Which of the following actions should the nurse recommend to the caregiver?

Correct Answer is B

Explanation

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Correct Answer is []

Explanation

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