The nurse identifies which of the following as the most common cause of a myocardial infarction?

Atherosclerosis

Obesity

Hypertension

Diabetes Mellitus type 2

Answer and Explanation

The Correct Answer is A

A. Atherosclerosis is correct. It is the primary cause of myocardial infarction (MI) due to the narrowing and eventual blockage of coronary arteries by plaque buildup, leading to reduced oxygen supply to the heart muscle.
B. Obesity is a risk factor for MI but is not the direct cause. It contributes to conditions like hypertension, diabetes, and atherosclerosis, which increase MI risk.
C. Hypertension increases the risk of MI by damaging blood vessels over time, but it is not the most common direct cause.
D. Diabetes Mellitus type 2 is a risk factor because it contributes to vascular damage and atherosclerosis, but it is not the primary cause of an MI.

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Correct Answer is C

Explanation

A. Encouraging increased fluid intake is incorrect. Clients with heart failure are at risk for fluid overload, and excessive fluid intake can worsen symptoms.
B. Simply monitoring and documenting findings is insufficient. A 2-pound weight gain in a short period suggests fluid retention and worsening heart failure, requiring further assessment and possible intervention.
C. Performing a head-to-toe assessment, including vital signs, is correct. The nurse should assess for worsening heart failure, including lung sounds (crackles), respiratory effort, blood pressure, and oxygen saturation, to determine if immediate interventions are needed.
D. Checking code status is not the priority. While knowing a client’s code status is important, the immediate concern is assessing for signs of fluid overload and potential decompensation.

A. Dizziness B. Crackles in the lungs C. Dry hacking cough D. Hepatomegaly

Correct Answer is D

Explanation

A. Dizziness is more commonly associated with left-sided heart failure due to decreased cardiac output and reduced cerebral perfusion.
B. Crackles in the lungs occur in left-sided heart failure due to pulmonary congestion. Right-sided heart failure primarily affects systemic circulation rather than the lungs.
C. A dry hacking cough is also a symptom of left-sided heart failure, resulting from fluid backup into the lungs.
D. Hepatomegaly is correct. Right-sided heart failure leads to systemic venous congestion, which can cause liver enlargement (hepatomegaly), ascites, and peripheral edema.

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The nurse identifies which of the following as the most common cause of a myocardial infarction?

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Naxlex Comprehensive Predictor Exams

A client with a history of heart failure on daily weights has a 2-pound weight gain and pitting edema in bilateral lower extremities. Which action should the nurse take next?

Correct Answer is C

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Correct Answer is D

Explanation

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