A nurse is caring for a client who has a history of hypertension. Which of the following findings should the nurse recognize is indicative of transient ischemic attacks?

Epigastric pain

Seizure activity

Sudden loss of vision in one eye

Pain radiating down the left arm

Answer and Explanation

The Correct Answer is C

Choice A reason: Epigastric pain suggests GI issues, not TIAs. In hypertension, TIAs affect cerebral vessels, causing neurological deficits, not abdominal symptoms like this.

Choice B reason: Seizures stem from cortical irritation, not typical TIA vascular occlusion. Hypertension-related TIAs produce transient deficits, not convulsive activity usually.

Choice C reason: Sudden monocular vision loss (amaurosis fugax) is a classic TIA sign in hypertension. It reflects temporary retinal artery occlusion, resolving quickly.

Choice D reason: Left arm pain mimics cardiac issues, not TIAs. Hypertension TIAs target brain circulation, causing focal deficits, not referred pain patterns.

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Correct Answer is B

Explanation

Choice A reason: Bathing under running water risks temperature instability and drowning in newborns. This is unsafe, showing a lack of proper care understanding.

Choice B reason: Washing the face with a warm, wet washcloth without soap protects delicate skin, avoiding irritation. This aligns with newborn hygiene best practices.

Choice C reason: Moist towelettes often contain chemicals, unsuitable for newborn scalps. Warm water and cloth are gentler, so this reflects misunderstanding of care.

Choice D reason: Daily baths dry out newborn skin, increasing irritation risk. Spot cleaning is advised, making this an incorrect application of hygiene teaching.

A. Massage the affected extremity every 4 hr. B. Initiate bed rest. C. Apply an ice pack to the affected extremity for 20 min every 2 hr. D. Administer aspirin for pain.

Correct Answer is B

Explanation

Choice A reason: Massaging a DVT risks dislodging the clot, causing embolism. In postpartum with anticoagulants, this is contraindicated to prevent lethal complications.

Choice B reason: Bed rest minimizes clot movement in DVT, aiding anticoagulation postpartum. It reduces embolism risk, a critical safety measure in this scenario.

Choice C reason: Ice may reduce swelling, but it’s not standard for DVT with anticoagulants. Elevation and rest are prioritized over cold therapy here.

Choice D reason: Aspirin isn’t used with anticoagulants like heparin; it increases bleeding risk. Postpartum DVT needs specific pain management, not this drug.

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A nurse is caring for a client who has a history of hypertension. Which of the following findings should the nurse recognize is indicative of transient ischemic attacks?

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