A 72-year old man has come to immediate care because he has been "feeling confused for a couple of days"; today, however, he feels like he might pass out and is short of breath
When the nurse questions him about chest pain, he states he just has "heartburn." The nurse's greatest concern is that he:
A) Is very agitated and now has an upset stomach
B) Has come to the clinic because he is depressed and wants to talk with someone
C) May be under too much stress and is having an anxiety attack
D) May be having a heart attack and does not realize it
Ans: D
Feedback: Careful assessment of older people is necessary, because they often present with different symptoms than those seen in younger patients. Older people are more likely to have dyspnea or neurologic symptoms associated with heart disease, and they may experience mental status changes or report vague symptoms such as fatigue, nausea, and syncope. A patient who has been feeling confused for a couple of days, short of breath, and having heartburn may be having a heart attack. Options A, B, and C all represent a legitimate concern or possible diagnosis, but in any patient experiencing chest pain "always treat chest pain as cardiac related until ruled otherwise."
You might also like to view...
A patient is receiving an experimental drug for leukemia. The nurse is worried that the drug may cause a reduction in platelets leading to intestinal tract bleeding. Which type of nursing diagnosis should the nurse use to address this concern?
a. Risk b. Actual c. Health-promotion d. Medical diagnosis
A Hispanic client whose only child died of pneumonia over a year ago states that she is unable to go
about her usual home duties and community interactions because of debilitating headaches and backaches. The psychiatrist diagnoses depression. Her primary care nurse tells the clinical nurse specialist "I can't seem to help her. All she talks about are the headaches and the backaches.". The clinical nurse specialist can foster the cultural competence of the nurse by saying a. "You need to be patient and let her take the lead.". b. "You must take the lead and focus on the reason for her resistance.". c. "In her culture, physical symptoms are idioms of distress expressing emotional pain.". d. "You might ask the client why she has chosen to grieve for her child in this particular way.".
A nurse counsels a patient who is to begin taking phenytoin [Dilantin] for epilepsy. Which statement by the patient indicates understanding of the teaching?
a. "I should brush and floss my teeth regu-larly." b. "Once therapeutic blood levels are reached, they are easy to maintain." c. "I can consume alcohol in moderation while taking this drug." d. "Rashes are a common side effect but are not serious."
Which of the following assessment findings would suggest the elderly patient may be a victim of abuse?
a. lentigo senilis c. vague explanations for cause of injuries b. presbycusis d. openness to strangers