A nurse is caring for a client post cardiac catheterization via the right groin site. The nurse is aware that which of the following findings needs to be reported to the interventional cardiologist as soon as it is identified.
Swelling at the insertion site and cool extremity
Oozing blood from the insertions site
The client has not voided since returning to recovery.
Blood pressure reading of 110/70 and heart rate of 90
The Correct Answer is A
Rationale:
A. Swelling at the insertion site and cool extremity may indicate bleeding or hematoma formation at the site.
B. Oozing blood from the insertion site is expected immediately after a cardiac catheterization.
C. The client has not voided since returning to recovery is not related to the cardiac catheterization.
D. Blood pressure reading of 110/70 and heart rate of 90 are within normal limits.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Rationale:
A. Notifying the provider of the client's allergy is the priority to ensure that appropriate precautions are taken during the cardiac catheterization.
B. Notifying the dietary department is not necessary in this situation.
C. Asking about other foods is important but not the priority at this time.
D. Attaching a wristband indicating the allergy may be done later but is not the priority at this time.
Correct Answer is A
Explanation
Rationale:
A. Petechiae are small, pinpoint red or purple spots on the skin that may indicate bleeding or thrombocytopenia, which can be a side effect of heparin therapy.
B. Slowing pulse rate is not typically associated with heparin therapy.
C. Confusion is not typically associated with heparin therapy.
D. Pruritus (itching) is not typically associated with heparin therapy.
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