The nurse working in a physician's office admits a client with a history of transient ischemic attacks (TIA) who was advised to lose weight, change diet to lower cholesterol, and maintain treatment of hypertension
The client has chosen not to take this advice, leading the nurse to conclude the client is at increased risk for: 1. Cerebrovascular accident.
2. Aneurysm.
3. Vasovagal syndrome.
4. Myasthenia gravis.
1
Rationale: TIA is often a precursor to CVA, and the client who chooses not to change his lifestyle to reduce risks is at increased risk.
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A patient, diagnosed with heart failure, would like the nurse to explain what the diagnosis means. How will the nurse explain heart failure?
A) The heart muscle cannot pump effectively causing a backup of blood. B) The hydrostatic pressure pushing fluid out of the capillaries is lower than the oncotic pressure. C) The decrease in venous pressure from the backup of blood increases hydrostatic pressure. D) Increased protein leads to reduced oncotic pressure and inability to pull fluid into the system.
Patient teaching regarding infection prevention for the patient with an immunodeficiency includes which of the following guidelines?
A) Cook all food thoroughly. B) Refrain from using creams or emollients on skin. C) Maintain contact only with individuals who have recently been vaccinated. D) Take OTC vitamin supplements consistently.
Which nursing diagnosis is appropriate for all patients with an anxiety, a somatoform, or a dissociative disorder?
a. Altered nutrition, less than body require-ments b. Disturbed body image c. Ineffective denial d. Ineffective coping
A patient with a T5 spinal cord injury has manifestations of autonomic dysreflexia
Which assessments would indicate a possible cause for this condition? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Presence of a pressure ulcer 2. Kinked urinary catheter tubing 3. Respiratory congestion 4. Diarrhea 5. Fecal impaction