Patient Data
Based on the results of the echocardiogram, the physician has decided to repair the ventricular septal defect via cardiac catheterization. What should the nurse’s focused assessment include before the cardiac catheterization? Select all that apply.
Obtain a history of allergic reactions
Document lying, sitting, and standing blood pressures
Perform a mini mental exam on the child
Determine when the child last ate
Locate and mark the pedal pulses
Measure the child’s height and weight
Correct Answer : A,B,D,E
Choice A reason: Obtaining a history of allergic reactions is crucial because the child will be exposed to various substances during cardiac catheterization, such as contrast dye, which could potentially cause an allergic reaction.
Choice B reason: Documenting lying, sitting, and standing blood pressures is important to assess for orthostatic hypotension, which could indicate volume depletion or cardiovascular problems that need to be addressed before the procedure.
Choice C reason: Performing a mini mental exam on the child is not typically part of the pre-procedure assessment for cardiac catheterization, especially given the young age of the child.
Choice D reason: Determining when the child last ate is essential because the child needs to have an empty stomach to reduce the risk of aspiration during sedation.
Choice E reason: Locating and marking the pedal pulses is important to establish baseline data so that post-procedure, any changes in the strength or presence of these pulses can be quickly identified, indicating potential complications.
Choice F reason: Measuring the child’s height and weight is generally part of a routine assessment but is not specifically focused on the pre-cardiac catheterization assessment unless dosing of medication or anesthesia is required based on weight.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Understanding the reason for taking aspirin is crucial because it could be for a chronic condition that requires antiplatelet action, which ibuprofen does not provide. Aspirin is often prescribed for its antiplatelet effect to prevent blood clots, while ibuprofen is primarily used for pain and inflammation.
Choice B reason: While the dosage of ibuprofen is important, it is secondary to understanding the purpose of the aspirin therapy. Overdosing on ibuprofen can lead to serious side effects, but the immediate risk of stopping aspirin without a suitable substitute could be more critical.
Choice C reason: Assessing the amount of pain control is important to evaluate the effectiveness of ibuprofen as a substitute for aspirin. However, this does not address the potential risks associated with the cessation of aspirin, especially if it was prescribed for cardiovascular reasons.
Choice D reason: The presence of gastric pain could indicate an adverse reaction to ibuprofen, which is known to cause gastrointestinal issues. However, this information is not as immediately necessary as understanding the reason for aspirin therapy, which could have significant implications for the client's health.
Correct Answer is B
Explanation
Choice A reason: Glaucoma is not directly related to the administration of lidocaine, as it does not affect intraocular pressure or the pathophysiology of glaucoma.
Choice B reason: Heart block is a type of arrhythmia where the electrical signal is delayed or blocked entirely. Since lidocaine affects cardiac conduction, it is crucial to review the medical record for heart block before administration.
Choice C reason: Gastric ulcers are not typically a concern when administering lidocaine, as it does not have gastrointestinal effects when given parenterally.
Choice D reason: Diabetes mellitus is not a contraindication for lidocaine administration; however, monitoring blood glucose levels is always important in diabetic patients receiving any medication.

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