A nurse is planning care for a client who has suspected cardiac tamponade. Which of the following diagnostic tests should the nurse anticipate the provider to order first?

Computed tomography (CT) scan

Chest x-ray

Echocardiogram

Electrocardiogram (ECG)

Answer and Explanation

The Correct Answer is C

A) Computed tomography (CT) scan: A CT scan may provide detailed images of the heart and surrounding structures, but it is not typically the initial diagnostic test used to assess for cardiac tamponade. CT scans are often used in conjunction with other diagnostic tests but are not the first-line investigation for suspected tamponade.

B) Chest x-ray: While a chest x-ray may show signs of cardiac tamponade, such as an enlarged cardiac silhouette or evidence of fluid accumulation around the heart, it is not as sensitive or specific as other diagnostic tests, particularly in the acute setting. Chest x-rays may be obtained as part of the diagnostic workup, but they are not the first-line test for suspected tamponade.

C) Echocardiogram: An echocardiogram is the most appropriate initial diagnostic test for suspected cardiac tamponade. It provides real-time imaging of the heart and can detect pericardial effusion, collapse of the right atrium and ventricle during diastole (diastolic collapse), and signs of hemodynamic compromise. Echocardiography allows for rapid assessment at the bedside and can guide immediate management decisions.

D) Electrocardiogram (ECG): While an electrocardiogram may show nonspecific changes in cardiac tamponade, such as low-voltage QRS complexes or electrical alternans, it is not as sensitive or specific as an echocardiogram for diagnosing tamponade. ECG findings may support the diagnosis but are not typically the first-line test for suspected tamponade.

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Correct Answer is C

Explanation

A. Lisinopril: Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor commonly used to treat hypertension and heart failure. It is not typically contraindicated for cataract extraction surgery, and it does not significantly increase the risk of bleeding.

B. Synthroid: Synthroid is a synthetic form of thyroid hormone used to treat hypothyroidism. It does not have any direct contraindications with cataract extraction surgery and does not significantly increase the risk of bleeding.

C. Clopidogrel: Clopidogrel is an antiplatelet medication commonly used to prevent blood clots in individuals with cardiovascular diseases such as coronary artery disease or recent myocardial infarction. However, it can increase the risk of bleeding, which may be problematic during cataract extraction surgery. Therefore, it is important to question administering clopidogrel prior to the procedure and potentially coordinate with the healthcare provider regarding its management.

D. Omeprazole: Omeprazole is a proton pump inhibitor used to reduce stomach acid production and treat conditions such as gastroesophageal reflux disease (GERD) and peptic ulcer disease. It does not have any direct contraindications with cataract extraction surgery and does not significantly increase the risk of bleeding.

A. Hallucinations B. Paranoia C. Lethargy D. Impulsivity E. Disregard for caregiver's feelings

Correct Answer is ["A","B","D","E"]

Explanation

A. Hallucinations: As dementia progresses, especially in conditions like Alzheimer's disease, sensory perceptions can become distorted, leading to hallucinations, where the person perceives things that are not present.

B. Paranoia: Paranoia, or irrational suspicions and mistrust, often increases as dementia progresses. The person may become increasingly fearful or suspicious of others, even caregivers or family members.

C. Lethargy: While lethargy can be a symptom of dementia, it is more commonly associated with the earlier stages of the disorder when the person may experience apathy, lack of interest, and reduced energy levels. As the disease progresses, other behavioral changes like agitation or restlessness may become more prominent.

D. Impulsivity: Impulsivity, or acting without forethought or consideration of consequences, can increase as dementia progresses, particularly in certain types of dementia like frontotemporal dementia. This can manifest as impulsive behaviors such as excessive spending, inappropriate social behavior, or risky actions.

E. Disregard for caregiver's feelings: As dementia advances, the person's ability to empathize or recognize the feelings and needs of others may decline. They may become increasingly self-focused or unaware of the impact of their actions on caregivers, leading to behaviors that disregard or overlook the caregiver's feelings and well-being.

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A nurse is planning care for a client who has suspected cardiac tamponade. Which of the following diagnostic tests should the nurse anticipate the provider to order first?

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