Cardiovasc
A patient with left-sided heart failure reports shortness of breath when lying flat and has crackles in both lungs. Which manifestation is most associated with left-sided heart failure?
Pulmonary congestion
A patient with impetigo asks what the lesions will look like. Which description should the nurse provide?
Honey-colored crusted lesions
A patient with hepatitis A asks how the disease is commonly transmitted. What should the nurse say?
Through the fecal-oral route
A patient with sickle cell disease asks how to help prevent a pain crisis. Which teaching is most appropriate?
Stay hydrated and avoid extreme temperatures
A patient with a stroke has difficulty understanding spoken language. Which deficit is the patient experiencing?
Wernicke’s aphasia
A nurse is teaching a patient with heart failure about diet changes. Which instruction is most important?
Restrict sodium intake to about 2 grams per day
A patient with herpes simplex virus asks how to reduce outbreaks. Which teaching is most appropriate?
Avoid stress, fatigue, and sunburn when possible
A patient with ascites from cirrhosis should be taught to report which finding immediately?
Rapid weight gain
A nurse is caring for a patient with hemophilia A who has active bleeding into a joint. Which intervention is most appropriate?
Administer clotting factor replacement immediately
A patient with PAD is taught proper foot care. Which instruction is most important?
Inspect the feet daily for injury or breakdown
A patient with peripheral artery disease reports leg pain during walking. Which nursing instruction is most appropriate?
Walk regularly and rest when pain occurs
A nurse is caring for a patient with cellulitis of the leg. Which intervention will best help decrease swelling?
Elevate the affected extremity
A patient with pancreatitis is prescribed NPO status. What is the purpose of this intervention?
To decrease pancreatic stimulation
A patient with immune thrombocytopenic purpura has a platelet count of 18,000/mm³. Which nursing priority is most important?
Monitor for signs of bleeding
A patient with a long bone fracture suddenly develops petechiae, confusion, and respiratory distress. Which complication should the nurse suspect?
Fat embolism
A patient develops sudden severe back pain, hypotension, and decreased urine output after previously being diagnosed with an abdominal aortic aneurysm. What should the nurse do first?
Notify the provider immediately for possible aneurysm rupture
A patient with psoriasis is prescribed methotrexate. Which laboratory values should the nurse monitor closely during therapy?
Liver function tests
A patient with cirrhosis develops confusion and elevated ammonia levels. Which medication should the nurse anticipate administering?
Lactulose
A patient receiving chemotherapy for lymphoma has a neutrophil count of 500/mm³. Which nursing intervention is priority?
Implement infection prevention precautions
A patient with compartment syndrome reports worsening pain despite pain medication. Which additional finding would the nurse expect?
Pallor and decreased pulses
A patient with acute decompensated heart failure suddenly becomes extremely anxious, tachypneic, and begins coughing frothy pink sputum. Which nursing intervention should the nurse implement first?
Place the patient upright and administer oxygen
A patient with melanoma asks why surgical excision is recommended before chemotherapy or radiation. What is the best response?
Surgical removal is the primary treatment because it can completely remove localized melanoma before metastasis occurs
A patient with acute pancreatitis develops hypotension, crackles, tachypnea, and severe hypocalcemia. Which complication should the nurse suspect?
Acute respiratory distress syndrome (ARDS)
A septic patient develops oozing from IV sites, petechiae, prolonged PT/aPTT, and elevated D-dimer levels. Which treatment priority is most important?
Treat the underlying cause of DIC
A patient with a hemorrhagic stroke suddenly develops fixed dilated pupils and decreasing level of consciousness. What is the nurse’s priority action?
Prepare for emergency intervention and notify the provider immediately