A patient who has chronic heart failure is admitted to the emergency department with severe dyspnea and a dry, hacking cough. Which action would the nurse take first?.
Auscultate the breath sounds.
Check the capillary refill.
Auscultate the abdomen.
Ask about the patient's allergies.
The Correct Answer is A
Choice A rationale:
In a patient with severe dyspnea and a dry, hacking cough, auscultating the breath sounds would be the first action to assess for any abnormalities.
Choice B rationale:
Checking the capillary refill would not be the first action as it does not directly relate to the symptoms of severe dyspnea and a dry, hacking cough.
Choice C rationale:
Auscultating the abdomen would not be the first action as it does not directly relate to the symptoms of severe dyspnea and a dry, hacking cough.
Choice D rationale:
Asking about the patient’s allergies would not be the first action as it does not directly relate to the symptoms of severe dyspnea and a dry, hacking cough.
So, the correct answer is A, after analyzing all choices.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
A weight increase from 120 pounds to 122 pounds over 3 days is within the normal fluctuation range.
Choice B rationale:
A serum potassium level of 3.0 mEq/L after 1 week of therapy is concerning because it’s below the normal range (3.5-5.0 mEq/L)171819. This could indicate hypokalemia, which can cause serious complications if left untreated.
Choice C rationale:
A palpable liver edge 2 cm below the ribs on the right side could suggest an abnormality such as an enlarged liver.
Choice D rationale:
The presence of 1+ to 2+ edema in the feet and ankles could indicate conditions like heart failure or venous insufficiency.
So, the correct answer is Choice B, after analyzing all choices.
Correct Answer is C
Explanation
Choice A rationale:
This is correct. Standing still for prolonged periods can cause blood to pool in the legs, increasing blood pressure.
Choice B rationale:
This is also correct. Stopping the medication abruptly can cause a rebound increase in blood pressure.
Choice C rationale:
This is incorrect. Furosemide is a diuretic that can cause the body to lose potassium, so it’s important to consume potassium-rich foods.
Choice D rationale:
This is correct. Furosemide can cause orthostatic hypotension, a form of low blood pressure that happens when you stand up from sitting or lying down.
So, the correct answer is Choice C, after analyzing all choices.
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