A nurse is assessing a client’s pulmonary artery wedge pressure (PAWP). The nurse should recognize that an elevated PAWP indicates which of the following complications?

Cardiogenic shock

Left ventricular failure

Hypotension

Hypovolemia

Answer and Explanation

The Correct Answer is B

Choice A reason: Cardiogenic shock involves reduced cardiac output, typically with low PAWP due to decreased preload from poor heart function. Elevated PAWP reflects left atrial pressure buildup, not characteristic of cardiogenic shock alone, which is distinct from heart failure, requiring specific hemodynamic management.
Choice B reason: Elevated PAWP indicates left ventricular failure, where the heart cannot pump blood effectively, causing pulmonary congestion. This increases left atrial pressure, leading to pulmonary edema, a hallmark of heart failure. Diuretics and inotropes are needed to reduce fluid overload and improve cardiac function.
Choice C reason: Hypotension is a symptom, not a direct complication of elevated PAWP. It may occur in heart failure due to reduced cardiac output, but elevated PAWP specifically signals left heart dysfunction, not hypotension itself, which is a systemic response rather than a primary cardiac issue.
Choice D reason: Hypovolemia reduces blood volume, lowering PAWP due to decreased preload. Elevated PAWP suggests fluid overload or left ventricular dysfunction, not hypovolemia, which presents with low central venous pressure and dehydration signs, requiring fluid resuscitation rather than management of heart failure.

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Correct Answer is A

Explanation

Choice A reason: Using a mechanical lift for a 136 kg client unable to assist ensures safety for both client and nurse. Lifts prevent injury by supporting the client’s weight, reducing strain on staff. This adheres to safe patient handling guidelines, minimizing risks of falls or musculoskeletal injuries during transfer.
Choice B reason: Asking another nurse to assist is insufficient for a 136 kg client unable to help, as manual lifting risks injury to staff and client. Mechanical lifts are required for heavy or non-assistive clients to ensure safety, making this option inadequate and unsafe for the transfer scenario described.
Choice C reason: Positioning the client upright before transfer is impractical for a non-assistive client weighing 136 kg, as it requires significant manual effort and risks injury. Mechanical lifts are needed to safely move such clients, ensuring stability and preventing falls, making this action inappropriate for the transfer.
Choice D reason: A sliding board is unsuitable for a 136 kg client unable to assist, as it requires some patient cooperation and strength. It risks injury to staff and client due to the client’s weight and inability to participate. Mechanical lifts are the safer, recommended method for this transfer.

A. Dry cough B. Increased urinary frequency C. Excessive sweating D. Metallic taste in mouth

Correct Answer is C

Explanation

Choice A reason: Dry cough is not associated with sertraline, an SSRI affecting serotonin pathways. Cough is linked to ACE inhibitors via bradykinin accumulation, not SSRIs, which cause neurological or gastrointestinal side effects. Including this misinforms the client about sertraline’s actual adverse effect profile.
Choice B reason: Increased urinary frequency is not a common sertraline side effect. SSRIs may cause urinary retention due to anticholinergic effects, but frequent urination is linked to diuretics or diabetes. Sertraline’s effects focus on serotonin-mediated mood changes, not bladder function alterations.
Choice C reason: Excessive sweating is a recognized sertraline adverse effect, driven by serotonin’s influence on autonomic sweat gland regulation. This hyperhidrosis, common in SSRI therapy, affects patient comfort and adherence, requiring education to prepare clients for this side effect during depression treatment.
Choice D reason: Metallic taste is not linked to sertraline. It occurs with antibiotics or chemotherapy agents due to oral mucosa irritation. Sertraline’s side effects include nausea or insomnia, driven by serotonin modulation, not gustatory changes, making this an incorrect inclusion in teaching.

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A nurse is assessing a client’s pulmonary artery wedge pressure (PAWP). The nurse should recognize that an elevated PAWP indicates which of the following complications?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is planning to transfer a client who weighs 136 kg (300 lb) from a bed to a chair. The client is unable to assist in the transfer. Which of the following actions should the nurse plan to take?

Correct Answer is A

Explanation

A nurse is providing teaching to a client about the adverse effects of sertraline. Which of the following adverse effects should the nurse include?

Correct Answer is C

Explanation

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