A nurse is caring for a client post-abdominal aortic aneurysm repair. What is the priority nursing action to detect potential complications?
Monitoring hourly urine output
Assisting with early ambulation
Assessing pedal pulses bilaterally
Monitoring blood glucose levels
The Correct Answer is C
A) Incorrect - While monitoring urine output is essential, it is not the priority for a client post-abdominal aortic aneurysm repair. Other assessments take precedence to detect immediate complications.
B) Incorrect - Assisting with early ambulation is important for postoperative recovery, but it is not the priority when there might be a risk of complications from the surgery.
C) Correct - Assessing pedal pulses bilaterally is the priority nursing action post-abdominal aortic aneurysm repair. Diminished or absent pedal pulses could indicate compromised blood flow to the lower extremities, possibly due to a clot or embolism.
D) Incorrect - Monitoring blood glucose levels is relevant for some clients, but it is not the priority in this situation, unless the client has a specific history of diabetes or altered glucose levels that could impact their recovery.
Questions
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A) Incorrect - Regular physical exercise is not a risk factor for aneurysms. In fact, it is associated with a reduced risk of various cardiovascular diseases, including some peripheral vascular disorders.
B) Correct - Hypertension is a significant risk factor for the development of aneurysms. Elevated blood pressure can weaken arterial walls, increasing the risk of aneurysm formation and rupture.
C) Incorrect - A low LDL level below 100 mg/dL is generally considered a healthy lipid profile and is not a risk factor for aneurysms. However, high LDL levels are associated with atherosclerosis and peripheral vascular disorders.
D) Incorrect - A vegetarian diet is not a risk factor for aneurysms. In fact, a diet rich in fruits, vegetables, and whole grains may reduce the risk of cardiovascular diseases, including aneurysms.
Correct Answer is B
Explanation
A) Incorrect - While surgical repair is an option for larger or symptomatic AAAs, it is not the only treatment option for small, asymptomatic AAAs.
B) Correct - For small asymptomatic AAAs, close monitoring of the aneurysm size and growth is a common approach. The size and rate of growth will determine the appropriate treatment plan.
C) Incorrect - Blood-thinning medications are not the standard treatment for small asymptomatic AAAs. These medications are generally used for other cardiovascular conditions.
D) Incorrect - Endovascular repair may be an option for some AAAs, but it is not the best treatment for all cases, especially small, asymptomatic ones. The appropriate treatment plan will depend on the client's specific circumstances.
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