On examination, the nurse would expect what finding if a client is in right-sided heart failure?
Increased jugular venous pressure
Decreased right-sided volume
Decreased stroke volume
Decreased central venous pressure
The Correct Answer is A
A. Increased jugular venous pressure: Right-sided heart failure often leads to increased jugular venous pressure due to the backup of blood in the systemic venous system.
B. Decreased right-sided volume: Right-sided heart failure typically results in increased blood volume in the right heart chambers, not decreased.
C. Decreased stroke volume: While right-sided heart failure can affect stroke volume, increased jugular venous pressure is a more direct indicator of right-sided heart failure.
D. Decreased central venous pressure: Right-sided heart failure usually results in increased, not decreased, central venous pressure.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Auscultating the area may not provide accurate information about the pulse if it is not palpable, though it can be part of the assessment if Doppler is unavailable.
B. Using Doppler ultrasonography is the most appropriate next step to accurately assess the pulse if it is not palpable, especially in older adults where pulses may be difficult to detect.
C. Asking another nurse to assess the pulse may not address the underlying issue of why the pulse is not palpable and does not provide additional information.
D. Documenting the absence of the dorsalis pedis pulse without further investigation could be premature, as Doppler ultrasonography should be used to confirm its absence.
Correct Answer is ["A","C","E"]
Explanation
A. Caffeine intake: Can cause a temporary increase in blood pressure due to its stimulant effects.
B. Post meal: While eating can cause temporary changes in blood pressure, it is less likely to be a significant factor compared to other causes.
C. Stress: Can lead to temporary increases in blood pressure due to the body's stress response.
D. Drinking a glass of water: Typically does not significantly affect blood pressure unless there is an underlying issue such as dehydration.
E. Time of day: Blood pressure can naturally vary throughout the day, often being higher in the morning and lower in the evening.
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