The nurse is assessing a client with a diagnosis of mitral stenosis. Which piece of assessment data indicates that the disease is worsening?

Jugular vein distention and +3 peripheral edema

Increase in systolic blood pressure 10 mmHg above cents norm

Complaints of epigastric pain after eating a large meal

Complaints of dyspnea while completing ADLs

Answer and Explanation

The Correct Answer is A

A. Jugular vein distention and +3 peripheral edema are signs of right-sided heart failure, which can result from worsening mitral stenosis. As the mitral valve becomes more narrowed, it leads to increased pressure in the left atrium and eventually backs up into the lungs and right side of the heart, causing fluid retention.
B. An increase in systolic blood pressure by 10 mmHg does not directly indicate worsening mitral stenosis. Blood pressure changes can occur for various reasons but are not as specific as signs of heart failure in this context.
C. Complaints of epigastric pain after eating a large meal are typically related to gastrointestinal issues rather than directly indicating worsening mitral stenosis.
D. Complaints of dyspnea while completing activities of daily living (ADLs) can be a sign of worsening mitral stenosis, but the additional signs of jugular vein distention and edema are more definitive indicators of worsening disease.

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Correct Answer is D

Explanation

A. Hospice care is intended for clients who are no longer pursuing curative treatment. The focus shifts from curing the disease to providing comfort, pain management, and emotional support at the end of life.

B. Hospice care is specifically for individuals who have a prognosis of 6 months or less to live, assuming the illness runs its normal course. This eligibility criterion is central to receiving hospice services.

C. Hospice care can be provided in various settings, including the client’s home, a hospice facility, a hospital, or a long-term care facility. Admission to a specific facility is not a requirement.

D. Hospice care focuses on symptom management, pain control, and quality of life for clients who are terminally ill. The interdisciplinary hospice team addresses the physical, emotional, spiritual, and social needs of the client.

A. "I can't believe the doctor graduated from medical school. He doesn't know a thing about treating cancer?" B. "Even though I am not hurting right now. I don't feel like have the energy to get out of bed. C. The doctor has been so good to me. I know he has tried everything he can. It is just my time. D. The doctor says I only have a few months to live, but know he is exaggerating to get me to take my medication."

Correct Answer is D

Explanation

A. "I can't believe the doctor graduated from medical school. He doesn't know a thing about treating cancer?" This statement reflects anger rather than denial. In the anger stage of grief, individuals may direct their frustration toward others, including healthcare providers, feeling that they have been wronged or mistreated.

B. "Even though I am not hurting right now, I don't feel like I have the energy to get out of bed." This statement indicates depression rather than denial. Depression in the grieving process often includes feelings of fatigue, sadness, or a lack of motivation, and is characterized by a sense of hopelessness or resignation.

C. "The doctor has been so good to me. I know he has tried everything he can. It is just my time." This statement indicates acceptance, the final stage of the grief process. Acceptance involves coming to terms with the reality of the situation, recognizing that the end is near, and being at peace with it.

D. "The doctor says I only have a few months to live, but I know he is exaggerating to get me to take my medication." Denial is a defense mechanism in which the person refuses to accept the reality of the situation. In this case, the client is rejecting the doctor's prognosis, believing that the doctor is exaggerating, which is characteristic of the denial phase of grief.

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The nurse is assessing a client with a diagnosis of mitral stenosis. Which piece of assessment data indicates that the disease is worsening?

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