A nurse is reviewing the history and physical of a client who has right ventricular heart failure. Which of the following is an expected finding?
Crepitus
Elevated pulmonary artery pressure
Hepatosplenomegaly
Confusion
The Correct Answer is B
A. Crepitus is a finding associated with subcutaneous emphysema or gas accumulation under the skin, typically not directly related to right ventricular heart failure.
B. Right ventricular heart failure can lead to increased pressure in the pulmonary artery, resulting in symptoms such as dyspnea, fatigue, and possibly right-sided heart murmurs.
C. Hepatosplenomegaly (enlargement of the liver and spleen) is more commonly associated with conditions such as liver cirrhosis, not specifically right ventricular heart failure.
D. Confusion is not typically associated with right ventricular heart failure unless there are complications such as hypoxemia or impaired cerebral perfusion.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A.
A. Using a cell phone on the ear opposite to the pacemaker helps minimize the risk of electromagnetic interference with the pacemaker function.
B. Engaging in activities such as playing softball may not be appropriate immediately after pacemaker insertion. The client should follow specific activity restrictions as advised by the healthcare provider.
C. While performing arm exercises is generally beneficial for overall health, the client should avoid strenuous activities that may strain the upper body or disrupt the pacemaker leads
immediately after insertion.
D. Pacemaker battery replacement is typically scheduled based on the device's longevity and is performed in a healthcare facility, not the cardiologist's office. The client should follow up regularly with the healthcare provider for device checks and monitoring of battery status.
Correct Answer is A
Explanation
A.
A. The priority action is to remove the client from the source of carbon monoxide poisoning, which in this case is the kerosene space heater. Taking the client outdoors will provide fresh air and reduce exposure to carbon monoxide.
B. Wrapping blankets around the client may further exacerbate the symptoms by trapping the carbon monoxide, worsening the client's condition.
C. While loosening the client's clothing may improve ventilation, it is not as effective as removing the client from the source of exposure.
D. Opening the client's windows may help improve ventilation, but it is not as effective as taking the client outdoors to reduce exposure to carbon monoxide.
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