An adult with a history of cardiovascular disease comes to the clinic complaining of indigestion. Vital signs are heart rate 130 beats/minute, respirations 24 breaths/minute, and blood pressure 180/90 mm/Hg. Which finding should the practical nurse (PN) report immediately to the healthcare provider?
severe headache.
Left jaw discomfort.
Nausea with emesis.
Warm, flushed skin.
The Correct Answer is B
A. Severe headache: While concerning, a headache alone in this context may indicate hypertension or stress, but it is not as immediately life-threatening as potential cardiac ischemia. It should be assessed, but reporting is not the most urgent action.
B. Left jaw discomfort: Discomfort in the left jaw is a classic sign of myocardial ischemia or acute coronary syndrome, particularly in a client with a history of cardiovascular disease. Immediate reporting is essential to initiate prompt evaluation and treatment to prevent complications such as myocardial infarction.
C. Nausea with emesis: Nausea can accompany cardiac events, but by itself it is a nonspecific symptom. It requires monitoring but is not as urgent as signs of potential cardiac ischemia.
D. Warm, flushed skin: This finding may indicate fever or vasodilation, but it is not immediately life-threatening in the context of cardiovascular risk. It should be noted, but it does not necessitate immediate intervention compared with left jaw discomfort.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["2"]
Explanation
Calculate the total milligrams (mg) remaining in the container.
Available dosage = 40 mg per capsule
Number of capsules remaining = 4 capsules
Total mg remaining = 4 capsules × 40 mg/capsule
= 160 mg.
Prescribed dose = 80 mg PO daily.
Calculate the number of days the remaining medication will last.
Days supply = (Total mg remaining / Daily dose (mg/day))
= (160 mg / 80 mg/day)
= 2 days.
Correct Answer is A
Explanation
A. Selects the same site that was used for the previous injection: The PN should reteach this step because insulin injection sites must be rotated to prevent lipohypertrophy and uneven absorption. Repeated use of the same site can lead to tissue thickening, altered insulin uptake, and unpredictable glucose control.
B. Inserts the needle at a 90 degree angle to the skin surface: A 90-degree angle is appropriate for most adults using short insulin needles, ensuring proper subcutaneous delivery. The angle may be adjusted only for very thin clients or when using longer needles.
C. Uses a circular action when applying an alcohol pad to the site: Cleaning the site in a circular motion from the center outward helps reduce bacterial contamination before injection. This technique is correct and should continue to be reinforced.
D. Injects air into the insulin vial to displace the dose: Injecting air equal to the insulin dose into the vial helps maintain pressure balance and ensures accurate dose withdrawal. This is a proper and necessary step in insulin preparation.
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