After receiving report on the following patients, which patient should the nurse assess first?
a. Patient with rheumatic fever who has sharp chest pain with a deep breath
b. Patient with acute aortic regurgitation whose blood pressure is 86/54 mm Hg
c. Patient with infective endocarditis who has a murmur and splinter hemorrhages
d. Patient with dilated cardiomyopathy who has bilateral crackles at the lung bases
ANS: B
Hypotension in patients with acute aortic regurgitation may indicate cardiogenic shock. The nurse should immediately assess this patient for other findings such as dyspnea or chest pain. The findings in the other patients are typical of their diagnoses and do not indicate a need for urgent assessment and intervention.
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True False