The nurse is caring for a patient who is one day post-mastectomy and notes that she is sobbing and gasping for breath. What should the nurse do first?

Notify the registered nurse.

Raise the head of the bed.

Sit with her and listen to her concerns.

Ask the patient what is wrong.

Answer and Explanation

The Correct Answer is B

Choice A reason: Notifying the registered nurse is important but should come after initially assessing the patient's immediate needs.

Choice B reason: Raising the head of the bed may help with breathing but does not address the cause of the patient's distress.

Choice C reason: Sitting with her and listening to her concerns is supportive but should follow an initial assessment of why she is sobbing and gasping for breath.

Choice D reason: Asking the patient what is wrong is the first step in assessing the situation and providing appropriate care.

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Correct Answer is D

Explanation

Choice A reason: A sodium level of 138 milliequivalents per liter is within the normal range and does not indicate metastasis.

Choice B reason: A hemoglobin level of 10.5 grams per deciliter is slightly low but does not specifically indicate metastasis.

Choice C reason: A potassium level of 3.4 milliequivalents per liter is within the normal range and does not indicate metastasis.

Choice D reason: A calcium level of 12.5 milligrams per deciliter is elevated, which may indicate metastasis to the bones, a common site for breast cancer metastasis.

A. Auditory hallucinations B. Free-floating anxiety C. Flashbacks D. Delusions of grandeur

Correct Answer is C

Explanation

Choice A reason: Auditory hallucinations involve hearing voices or sounds that are not present, which does not match Audrey's experience of visual perceptions.

Choice B reason: Free-floating anxiety is a general feeling of unease that is not tied to a specific situation, whereas Audrey's anxiety is triggered by a specific scenario reminiscent of past trauma.

Choice C reason: Flashbacks are vivid, often distressing, memories of past traumatic events that feel as though they are happening in the present. Audrey's experience is indicative of flashbacks related to her military service.

Choice D reason: Delusions of grandeur involve beliefs of inflated worth, power, or identity, which is not described in Audrey's situation.

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The nurse is caring for a patient who is one day post-mastectomy and notes that she is sobbing and gasping for breath. What should the nurse do first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is reviewing lab data of a Stage 4 breast cancer patient. Which lab data may indicate further metastasis?

Correct Answer is D

Explanation

Audrey is a veteran who served in Afghanistan. She finds it very difficult to drive through a parking ramp because she perceives that "There are people hiding behind the pillars! They have guns! Be careful." Audrey is most likely experiencing which of the following?

Correct Answer is C

Explanation

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