The nurse is interviewing a client with a complex cardiac history. Which questions related to the client's history are most important to ask? Select all that apply.
Are you allergic to any medications or foods?
Do you have any children?
How did your mother die?
Have you had shortness of breath or weight gain?
How would you describe your symptoms?
Correct Answer : A,C,D,E
The questions related to the client's history that are most important to ask are:
How would you describe your symptoms?: This question is important to assess the client's current cardiac symptoms and determine the severity, duration, and nature of their symptoms. It helps the nurse to evaluate the client's cardiac status and determine appropriate interventions.
Are you allergic to any medications or foods?: This question is crucial to identify any potential allergies that could impact the client's cardiac care. It helps the nurse ensure that medications and interventions are safe for the client and prevent any adverse reactions.
How did your mother die?:This question is important to gather information about the client's family history of cardiac diseases and potential risk factors. Understanding the family history helps the nurse assess the client's genetic predisposition to cardiac conditions and plan appropriate interventions and screenings.
Have you had shortness of breath or weight gain? : This question is important to assess for symptoms of heart failure or fluid retention. Shortness of breath and weight gain can indicate fluid accumulation, which is a common symptom in cardiac conditions. It helps the nurse evaluate the client's cardiac function and determine the need for further interventions or medication adjustments.
Let's review the other options and explain why they are not the most important questions to ask:
Do you have any children?: While family history is important, specifically asking about children is not as relevant to the client's current cardiac condition. The focus should be on the client's own symptoms, medical history, and family history of cardiac diseases.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
The importance of ensuring the stockings are applied evenly with no pressure points: Compression stockings are designed to provide graduated pressure to the legs, helping improve blood flow and reduce swelling in individuals with venous insufficiency. It is crucial for the client to understand how to properly apply the stockings to maximize their effectiveness and prevent any complications. The nurse should emphasize the following points:
● Ensure the stockings are applied evenly: The stockings should be applied smoothly and evenly without any folds or wrinkles. This helps ensure that the pressure is distributed uniformly, enhancing their therapeutic effect.
● Check for pressure points: The client should be instructed to pay attention to any areas where the stockings may be causing excessive pressure or discomfort. Pressure points can impair circulation or cause skin damage. If pressure points are noticed, adjustments should be made to ensure proper fit and comfort.
● Follow manufacturer's instructions: The nurse should provide specific instructions regarding how to correctly don the compression stockings, including any specific guidelines provided by the manufacturer. This may include recommendations for the time of day to apply the stockings or any specific donning techniques.
The other options mentioned in the question are not essential information for the teaching plan:
The need to take anticoagulants concurrent with using compression stockings: While some individuals with venous insufficiency may require anticoagulant therapy, it is not directly related to the use of compression stockings. Anticoagulant therapy is typically prescribed for other reasons, such as prevention or treatment of blood clots.
The need to wear the stockings on a one day on, one day off schedule: Wearing compression stockings on a specific schedule of one day on, one day off is not a standard recommendation. The frequency and duration of wearing compression stockings may vary based on individual needs and healthcare provider's recommendations.
The importance of wearing the stockings around the clock to ensure maximum benefit: While consistent and regular use of compression stockings is important, it is not necessary to wear them around the clock. Healthcare providers typically provide specific guidelines on how long the stockings should be worn each day, which may vary based on the severity of venous insufficiency and individual factors.
Correct Answer is D
Explanation
The client reports a headache with pain at level 5 of 10.: While a headache can be a symptom of high blood pressure, a pain level of 5 out of 10 alone does not indicate an immediate life-threatening condition. It is important to assess and manage the client's pain, but it may not be the most critical finding to report in this situation.
The client has epistaxis after blowing his nose several times. : Epistaxis, or a nosebleed, can occur due to high blood pressure, but it is not the most urgent or critical symptom in a hypertensive emergency. While it is essential to address the nosebleed and monitor blood pressure, other symptoms may indicate more severe consequences of uncontrolled high blood pressure.
The client has a urine output of 120 mL over 4 hours.: While decreased urine output can be a concerning sign, it is not the most significant finding to report in a hypertensive emergency. In this scenario, the focus is on acute complications related to high blood pressure, such as organ damage or impending stroke, which require immediate attention.
In summary, the finding that is most important to report to the healthcare provider in a client with a hypertensive emergency is the presence of new-onset blurry vision and facial asymmetry. These symptoms suggest potential neurological involvement and the need for urgent medical intervention to prevent serious complications like stroke.
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