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Which medical treatment would be prescribed for the client with an AAA less than 3 cm?
- A. Ultrasound every six (6) months.
- B. Intravenous pyelogram yearly.
- C. Assessment of abdominal girth monthly.
- D. Repair of abdominal aortic aneurysm.
Correct Answer: A
Rationale: Small AAAs (<3 cm) are monitored with ultrasound every 6 months (A). IV pyelogram (B) is irrelevant, girth (C) is not standard, and repair (D) is for larger AAAs (>5.5 cm).
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Which dietary selection indicates the client with essential hypertension understands the discharge teaching?
- A. Fried pork chops, a loaded baked potato, and coffee.
- B. Spaghetti and meatballs, garlic bread, and iced tea.
- C. Baked ham, macaroni and cheese, and milk.
- D. Broiled fish, steamed broccoli, and garden salad.
Correct Answer: D
Rationale: Broiled fish, steamed broccoli, and salad (D) are low-sodium, low-fat, aligning with hypertension teaching. Pork chops (A), meatballs/bread (B), and ham/cheese (C) are high-sodium/fat.
Which question should the nurse ask the male client diagnosed with aortoiliac disease during the admission interview?
- A. Do you have trouble sitting for long periods of time?'
- B. How often do you have a bowel movement and urinate?'
- C. When you lie down, do you feel throbbing in your abdomen?'
- D. Have you experienced any problems having sexual intercourse?'
Correct Answer: D
Rationale: Aortoiliac disease can cause erectile dysfunction due to reduced pelvic blood flow, making sexual intercourse issues (D) relevant. Sitting (A), bowel/urination (B), and throbbing (C) are less specific.
The nurse is caring for clients on a medical floor. Which client will the nurse assess first?
- A. The client with an abdominal aortic aneurysm who is constipated.
- B. The client on bedrest who ambulated to the bathroom.
- C. The client with essential hypertension who has epistaxis and a headache.
- D. The client with arterial occlusive disease who has a decreased pedal pulse.
Correct Answer: D
Rationale: Decreased pedal pulse in arterial occlusive disease (D) suggests acute ischemia, a priority. Constipation (A), unauthorized ambulation (B), and epistaxis/headache (C) are less urgent.
Which complication should the nurse monitor for in a client with cardiomyopathy?
- A. Heart failure
- B. Hypoglycemia
- C. Osteoporosis
- D. Gastritis
Correct Answer: A
Rationale: Cardiomyopathy impairs heart function, increasing the risk of heart failure.
Which complication should the nurse monitor for in a client with pericarditis?
- A. Cardiac tamponade
- B. Pneumonia
- C. Renal failure
- D. Seizures
Correct Answer: A
Rationale: Cardiac tamponade is a serious complication of pericarditis, where fluid accumulation compresses the heart.