A nurse is preparing a client to undergo a cardiac catheterization.
Which of the following tasks should the nurse perform prior to the procedure?

Draw blood specimens for culture and sensitivity.

Obtain a CBC with differential.

Transport the client to radiology for a CT scan.

Administer nitroglycerin 0.4 mg SL 30 min before the procedure.

Answer and Explanation

The Correct Answer is B

The correct answer is choice b. Obtain a CBC with differential.

Choice A rationale:

Drawing blood specimens for culture and sensitivity is not typically required before a cardiac catheterization unless there is a specific concern about infection.

Choice B rationale:

Obtaining a CBC with differential is important to assess the client’s overall health and detect any potential issues such as anemia or infection that could complicate the procedure.

Choice C rationale:

Transporting the client to radiology for a CT scan is not a standard pre-procedure task for cardiac catheterization. This might be necessary if there are specific indications, but it is not routine.

Choice D rationale:

Administering nitroglycerin 0.4 mg SL 30 minutes before the procedure is not a standard practice for preparing a client for cardiac catheterization. Nitroglycerin is typically used to manage chest pain or angina, not as a pre-procedure medication.

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Correct Answer is A

Explanation

Choice A rationale:

Crackles in the lungs are a common manifestation of heart failure. Heart failure can cause fluid accumulation in the lungs, leading to crackles upon auscultation. This finding is due to pulmonary congestion and is indicative of heart failure exacerbation.

Choice B rationale:

Decreased thirst is not a typical manifestation of heart failure. In fact, patients with heart failure often experience increased thirst due to fluid shifts and increased blood volume, leading to increased urine output and dehydration.

Choice C rationale:

Poor skin turgor is not a specific manifestation of heart failure. Skin turgor is commonly assessed to determine hydration status, but it is not directly related to heart failure.

Choice D rationale:

Tachycardia (rapid heart rate) is a common manifestation of heart failure. The heart beats faster to compensate for its decreased pumping efficiency. Tachycardia helps maintain cardiac output, but it is not a primary cause of heart failure; instead, it is a physiological response to the condition.

A. Contact the family regarding the client's condition. B. Notify risk management. C. Inform the transferring agency of the client's condition. D. Privately interview the client about the injuries.

Correct Answer is D

Explanation

The correct answer is choice d. Privately interview the client about the injuries.

Choice A rationale:

Contacting the family regarding the client’s condition might not be appropriate if the family is suspected of being involved in the abuse. It could potentially put the client at further risk.

Choice B rationale:

Notifying risk management is important for documentation and internal review, but it does not directly address the immediate need to assess and ensure the client’s safety.

Choice C rationale:

Informing the transferring agency of the client’s condition is necessary for continuity of care, but it does not address the immediate need to investigate the cause of the injuries and ensure the client’s safety.

Choice D rationale:

Privately interviewing the client about the injuries allows the nurse to gather more information about the cause of the injuries in a safe and confidential manner. This step is crucial in assessing the situation and determining if further action, such as reporting to authorities, is needed. It ensures the client’s safety and helps in identifying any potential abuse.

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A nurse is preparing a client to undergo a cardiac catheterization. Which of the following tasks should the nurse perform prior to the procedure?

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A nurse is preparing a client to undergo a cardiac catheterization.
Which of the following tasks should the nurse perform prior to the procedure?