The nurse is caring for a group of patients. Which patient is the priority?

A patient with a BP of 170/80 mm Hg with a mild headache

A patient with a BP of 180/120 mm Hg who is asymptomatic

A patient with a BP of 150/60 mm Hg who is anxious

A patient with a blood pressure (BP) of 140/70 mm Hg who has a nosebleed

Answer and Explanation

The Correct Answer is B

A. A patient with a BP of 170/80 mm Hg with a mild headache: Although high, this BP is not as immediately critical as 180/120 mm Hg. The patient is experiencing only a mild headache, indicating less urgency.
B. A patient with a BP of 180/120 mm Hg who is asymptomatic: This BP level indicates a hypertensive crisis, which can lead to life-threatening complications such as stroke or heart attack, even if the patient is asymptomatic. Immediate intervention is needed to lower the BP safely.
C. A patient with a BP of 150/60 mm Hg who is anxious: This BP is elevated but not critically so. Anxiety management may be necessary but is not as urgent as managing a hypertensive crisis.
D. A patient with a blood pressure (BP) of 140/70 mm Hg who has a nosebleed: This BP is relatively mild compared to 180/120 mm Hg and is less immediately threatening, even with a nosebleed.

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Correct Answer is C

Explanation

A. Transient ischemic attack (TIA): A TIA might cause transient symptoms similar to a stroke, including weakness and dysphasia, but it would not explain why the symptoms are localized to the right side of the body. Additionally, TIA symptoms typically resolve within 24 hours.
B. Basilar artery syndrome: This type of stroke affects the brain stem, resulting in symptoms such as double vision, vertigo, and ataxia, rather than localized right-sided weakness and dysphasia.
C. Left middle cerebral artery syndrome: The left middle cerebral artery (MCA) supplies blood to the left hemisphere of the brain, including areas that control language and motor function on the right side of the body. Thus, an infarct in this area often leads to right-sided weakness and dysphasia, making it the most likely suspect.
D. Right middle cerebral artery syndrome: This would typically result in left-sided weakness and possibly neglect, but not right-sided symptoms

A. The right leg for shortening B. The left leg for internal rotation C. The left leg for loss of function D. The right knee for crepitation

Correct Answer is A

Explanation

Correct answer: A
A. The right leg for shortening: This is the most critical observation because crossing the legs after a hip replacement can cause hip dislocation. A shortened leg can be a sign of dislocation, which is a serious complication that requires immediate attention.
B. The left leg for internal rotation: Internal rotation is more of a concern for the operated leg (the right leg), not the left leg, in this context.
C. The left leg for loss of function: This is less relevant unless there is concern about a complication in the left leg, which is not directly related to the issue of crossing legs post-surgery.
D. The right knee for crepitation: Crepitation refers to a crackling sound and is more associated with joint issues rather than an indicator of hip dislocation.

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The nurse is caring for a group of patients. Which patient is the priority?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is caring for a patient who presents to the emergency department with right-sided weakness and dysphasia. Which type of stroke would the nurse suspect?

Correct Answer is C

Explanation

Correct Answer is A

Explanation

The nurse is caring for a group of patients. Which patient is the priority?

The nurse is teaching a patient about a thiazide-like diuretic. Which statement made by the patient indicates an understanding of the teaching?

The LPN/LVN is reinforcing education with an elderly patient diagnosed with diabetes and hypertension. Which topics would be vital for the nurse to emphasize? Select all that apply.

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When taking blood pressure medications, it is important to reinforce education with the patient on which topics? Select all that apply.