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A nurse is caring for a client in the clinic

Exhibits

Complete the following sentence by using the list of options.

The nurse should first address the client's
Answer and Explanation

The Correct Answer is {"dropdown-group-1":"C"}

  • Chest pain: Crushing, retrosternal chest pain is highly suggestive of cardiac ischemia or acute coronary syndrome. It requires immediate evaluation due to the risk of myocardial infarction. The presence of fatigue and weakness adds to the urgency. Chest pain is always prioritized due to its life-threatening potential.
  • Visual disturbance: Visual changes may indicate hypertension, hyperglycemia, or neurological issues. While concerning, they are typically not immediately life-threatening. These symptoms can be evaluated after cardiac causes are ruled out. They support further systemic investigation.
  • Fatigue: Fatigue is a nonspecific symptom seen in many chronic conditions like diabetes, anemia, or heart failure. It does not signal an emergency on its own. It may be related to underlying cardiac issues but is not prioritized over chest pain.
  • Increased urination: Polyuria often indicates uncontrolled blood glucose levels or diabetes. It should prompt further testing but does not require immediate intervention. It is a chronic symptom rather than an acute, life-threatening one.


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Related Questions

Correct Answer is D

Explanation

A. Blood urea nitrogen (BUN) 24 mg/dL: This BUN level is slightly elevated but not critical. It may indicate mild dehydration or increased protein breakdown, but it does not require immediate intervention in the context of SIADH.
B. Serum calcium 8.0 mg/dL: This value is at the lower end of normal. While low calcium levels may cause symptoms like muscle cramps or tingling, they are not the most urgent concern in a client with SIADH.
C. Serum potassium 5.0 mEq/L: This value is at the high end of normal. While potassium levels should be monitored, especially in critically ill clients, this level does not require emergency treatment.
D. Serum sodium 125 mEq/L: This sodium level is significantly low and requires immediate intervention. In SIADH, water retention leads to dilutional hyponatremia. A sodium level this low can cause neurologic symptoms such as confusion, seizures, or coma, making it a priority for urgent management.

Correct Answer is A

Explanation

A. Laminectomy: A laminectomy, while performed to relieve spinal nerve compression, may alter the biomechanics of the spine and lead to long-term instability. Over time, this can accelerate degeneration in adjacent spinal segments, increasing the risk for spinal stenosis recurrence or progression.
B. Hyperthyroidism: Hyperthyroidism affects metabolic rate and cardiovascular function but does not contribute to degenerative changes or structural narrowing of the spinal canal. It has no direct link to the development of spinal stenosis.
C. Hysterectomy: Although a hysterectomy may affect hormone levels, it has no anatomical relationship to the spine. It is not recognized as a contributing factor to the spinal canal narrowing seen in spinal stenosis.
D. Chronic obstructive pulmonary disease: COPD leads to respiratory impairment and reduced activity tolerance but is not associated with spinal degeneration. It does not cause the structural changes necessary for spinal stenosis to develop.

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