Patient data

The client has a known ventricular septal defect. The nurse assesses the client for signs of heart failure (HF). For each assessment finding, click to indicate whether findings are generally associated with impaired myocardial function, pulmonary congestion, or systemic venous congestion. Each row must have only one response option selected.

A. Finding out if the client can lie prone is not the most critical consideration. While some imaging procedures require specific positioning, most IV pyelograms can be performed with the client in a supine position, and the radiology team can adjust as needed. Inability to lie prone would not prevent the procedure, so this is a lower priority.

B. Asking about an allergy to shellfish is the most important action. IV pyelogram uses iodine-based contrast media, and clients with allergies to iodine or shellfish are at risk for hypersensitivity reactions, which can range from mild rash to life-threatening anaphylaxis. Screening for allergies is essential for client safety and takes priority over positioning, bowel prep, or medication considerations.

C. Determining the last bowel movement is helpful because bowel contents can interfere with visualization of the urinary tract during the x-ray. Sometimes bowel preparation is needed to improve imaging quality. However, this is secondary to the immediate safety concern of an allergic reaction.

D. Inquiring about regularly scheduled medications is important because some medications, such as metformin, may interact with contrast dye and need to be held before the procedure. Despite this, medication history is less urgent than identifying potential allergies that could lead to severe reactions.

A. Ventricular arrhythmias warrant immediate intervention because they indicate a life-threatening cardiac complication. Clients with a history of bilateral adrenalectomy are at risk for adrenal crisis, which can cause electrolyte imbalances such as hyperkalemia. Hyperkalemia can precipitate ventricular arrhythmias, making this a critical, time-sensitive finding requiring urgent treatment.

B. Profound weight gain may indicate fluid retention, which is important to monitor but is not immediately life-threatening. It requires assessment and intervention over time but does not take priority over a potentially fatal arrhythmia.

C. Decreased urinary output is a sign of compromised renal perfusion or fluid imbalance. While concerning, it is not as immediately life-threatening as ventricular arrhythmias and typically follows assessment and stabilization of cardiovascular status.

D. Low blood glucose levels (hypoglycemia) are important to identify and treat promptly in clients without adrenal function, but the immediate threat to life from ventricular arrhythmias takes precedence. Hypoglycemia should be treated after ensuring cardiac stability.