The nurse receives information about the assigned patients during shift report.
Which patient would the nurse assess first?

A patient who reports dizziness with a blood pressure (BP) of 150/92 mm Hg.

A patient who reports a severe headache and has begun vomiting.

A patient with a hip fracture who reports a pain level of 2 on a 1-to-10 scale.

A patient who received an angiotensin-converting enzyme (ACE) inhibitor 30 minutes previously and reports fatigue.

Answer and Explanation

The Correct Answer is B

Choice A rationale:

Dizziness with a blood pressure of 150/92 mm Hg indicates hypertension, but it is not an immediate life-threatening condition requiring urgent assessment compared to a severe headache and vomiting.

Choice B rationale:

A severe headache and vomiting could be indicative of a serious neurological condition such as a stroke, intracranial bleeding, or increased intracranial pressure. This patient needs urgent assessment and intervention to prevent potential complications.

Choice C rationale:

A hip fracture with a pain level of 2 on a 1-to-10 scale suggests pain but is not immediately life-threatening compared to symptoms like severe headache and vomiting.

Choice D rationale:

Fatigue after receiving an ACE inhibitor is a common side effect and, while important to monitor, does not pose an immediate threat compared to the symptoms of severe headache and vomiting.

Nursing Test Bank

Test Bank #1: RN Pharmacology Exams Test Bank #2: RN Medical-Surgical Exams Test Bank #3: RN Fundamentals Exams Test Bank #4: RN Maternal-Newborn Exams Test Bank #5: RN Anatomy and Physiology Exams Test Bank #6: RN Obstetrics and Pediatrics Exams Test Bank #7: RN Fluid and Electrolytes Exams Test Bank #9: RN Adult Health Test Bank #10: RN Dosage Calculation Test Bank #11: RN Community Health Exams Test Bank #12: RN Psychology Exams Test Bank #13: RN Nursing Care Of Children Test Bank #14: RN Foundations of Nursing Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Exam #1: RN Comprehensive predictor 2023 proctored exam Exam #2: Ati rn vati comprehensive predictor proctored exam Exam #3: Ati Rn Comprehensive Predictor Proctored Exam 2023 Exam #4: Rn Comprehensive Predictor 2023 Proctored Exam - St. Joseph Exam #5: RN Comprehensive Predictor Proctored Exam (National U CA San Diego) Exam #6: Ati rn comprehensive predictor 2023 retake proctored exam Exam #7: RN Hesi Exit Proctored Exam Exam #8: Hesi RN Exit proctored exam Exam #9: Hesi rn exit proctored exam Exam #10: Hesi Rn compass exit B proctored exam

Free Nursing Study Resources

Correct Answer is D

Explanation

Choice A rationale:

Taking a daily walk is a beneficial activity for patients with venous leg ulcers. Walking promotes blood circulation, which can aid in wound healing. This statement indicates that the patient understands the importance of physical activity for their condition.

Choice B rationale:

Trying to lose weight is another positive step for a patient with venous leg ulcers, especially if the patient is overweight. Excess body weight can put additional pressure on the veins in the legs, worsening venous insufficiency. Losing weight can alleviate this pressure and improve venous circulation, supporting the healing process of leg ulcers.

Choice C rationale:

Wearing stockings after getting out of bed is a proper technique for managing venous leg ulcers. Compression stockings help improve blood flow in the legs and reduce swelling, which is beneficial for patients with venous insufficiency and leg ulcers. This statement indicates that the patient understands the importance of wearing compression stockings consistently.

Choice D rationale:

Not wearing knee-high socks that are tight around the calf is essential advice for patients with venous leg ulcers. Tight clothing, including socks or stockings, can impede blood circulation in the legs, worsening venous insufficiency and delaying wound healing. This statement indicates the need for further education because the patient should avoid any tight clothing around the affected area to promote optimal blood flow and wound healing.

A. The patient has neutropenia. B. The patient has polycythemia. C. The patient has pernicious anemia. D. The patient has elevated estrogen levels.

Correct Answer is C

Explanation

Choice A rationale:

Neutropenia is a condition characterized by a low number of neutrophils, a type of white blood cell. Neutropenic patients are at increased risk of infections, but neutropenia does not cause specific changes in the tongue surface. The smooth and shiny tongue surface described in the question is not indicative of neutropenia.

Choice B rationale:

Polycythemia is a condition characterized by an abnormally high concentration of hemoglobin in the blood. It can cause the skin to appear reddish or flushed, but it does not directly cause changes in the tongue surface such as smoothness and shininess.

Choice C rationale:

Pernicious anemia is a type of anemia caused by a deficiency of vitamin B12, which is essential for the formation of red blood cells and the maintenance of the nervous system. One of the characteristic signs of pernicious anemia is glossitis, which is inflammation of the tongue that can make the tongue appear smooth and shiny. This finding aligns with the description provided in the question.

Choice D rationale:

Elevated estrogen levels can cause changes in the skin, such as increased pigmentation or the development of spider veins, but they do not directly cause changes in the tongue surface as described in the question.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

The nurse receives information about the assigned patients during shift report.Which patient would the nurse assess first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse provides discharge teaching to a patient with venous leg ulcers.Which statement made by the patient indicates the need for further education?

Correct Answer is D

Explanation

The nurse notes that a patient has a smooth and shiny tongue surface.The nurse would attribute these findings to which condition?

Correct Answer is C

Explanation

The nurse presents information to a group of nursing students about cultural and ethnic health disparities related to hypertension.Which information would the nurse include about the comparison of Mexican Americans to White and Black populations?

Which arterial blood gas (ABG) data corresponds with a patient's clinical manifestations of respiratory alkalosis?

In which type of water would a submersion injury cause the patient's fluid to be drawn from the vascular space into the alveoli, impairing alveolar ventilation and resulting in hypoxia?

The nurse provides education to a patient with thrombocytopenia about precautions to be taken at home. The nurse identifies that further teaching is needed when the patient performs which action?

A healthy 70-year-old patient has low hemoglobin levels and no signs of gastrointestinal bleeding.The nurse recognizes which item is an effect of aging that could be the reason for the low hemoglobin level?

Which manifestation is related to target organ disease from hypertension? Select all that apply.One, some, or all responses may be correct.

Which change occurs first, making patients susceptible to coronary artery disease?

A patient reports episodic chest pain lasting a few minutes that is provoked by exertion and relieved within 10 minutes upon resting.Which cause of the patient's symptoms would the nurse suspect?

The nurse receives information about the assigned patients during shift report.
Which patient would the nurse assess first?