Chamberlain University W8 NR302 Health Assessment I Exam 3 .
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Free Chamberlain University W8 NR302 Health Assessment I Exam 3 . Questions
The nurse assesses a pregnant client for cardiac complications. Which maternal report should prompt the nurse to further investigate potential cardiac complications in pregnancy?
- "I have been gaining weight and my ankles are swelling."
- "I have occasional heartburn and mild indigestion after spicy foods."
- "I have to nap in the afternoon and sometimes rest after lunch."
- "I get tired and short of breath when I walk up two flights of stairs."
Explanation
Correct Answer: D) "I get tired and short of breath when I walk up two flights of stairs."
Dyspnea on exertion, such as becoming tired and short of breath when climbing two flights of stairs, is a significant symptom that warrants further cardiac investigation in a pregnant client.
While some degree of breathlessness is common in pregnancy due to the growing uterus and increased circulatory demands, exertional dyspnea that limits normal activity may indicate an underlying cardiac condition such as peripartum cardiomyopathy or valvular disease.
Weight gain and ankle swelling are common normal findings in pregnancy. Heartburn and indigestion are typical gastrointestinal complaints during pregnancy. Afternoon fatigue and rest are also common and expected in pregnancy.
A nurse reviews the electronic health record (EHR) of a woman who experienced shortness of breath, fatigue, and nausea. She was initially treated for anxiety before being diagnosed with acute coronary syndrome (ACS). What could explain the initial misdiagnosis?
- Women often present with non-classic ACS symptoms
- Anxiety is a primary cause of ACS in women
- Laboratory tests are always abnormal in women with ACS
- Shortness of breath is rarely a cardiac symptom
Explanation
Correct Answer: A) Women often present with non-classic ACS symptoms
Women frequently present with atypical or non-classic symptoms of acute coronary syndrome, which differ from the classic presentation of crushing chest pain radiating to the left arm seen more commonly in men. Women's ACS symptoms often include shortness of breath, fatigue, nausea, jaw pain, and back pain, which can easily be mistaken for anxiety, gastrointestinal issues, or other non-cardiac conditions. This atypical presentation is a well-recognized contributor to delayed diagnosis and misdiagnosis of ACS in women, making awareness of these gender-specific differences essential in clinical practice.
A client asks the nurse to explain the benefits of weight management. How should the nurse respond?
- "Weight management helps reduce heart disease by increasing Low-Density Lipoprotein (LDL) cholesterol levels."
- "Weight management helps reduce heart disease by reducing the need for physical activity."
- "Weight management helps reduce heart disease by promoting the buildup of fatty deposits in the arteries."
- "Weight management helps reduce heart disease by lowering blood pressure and reducing heart strain."
Explanation
Correct Answer: D) "Weight management helps reduce heart disease by lowering blood pressure and reducing heart strain."
Maintaining a healthy weight reduces the workload on the heart by lowering blood pressure, improving lipid profiles, and reducing overall cardiovascular strain. Excess body weight is a major risk factor for hypertension, dyslipidemia, and heart disease, and effective weight management directly addresses these risk factors to reduce the likelihood of cardiovascular complications.
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The pupils remain the same size when focusing on a near object
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The pupils constrict and the eyes move inward as an object moves closer
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The pupils dilate when the nurse shines a light from the side
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The eyes move together when the nurse shines a light directly into one eye
Explanation
Accommodation is the eye's ability to adjust focus for near objects. The normal accommodation response involves three simultaneous changes: pupillary constriction, convergence of the eyes inward, and increased lens curvature. Observing pupil constriction and inward eye movement as an object approaches confirms a normal accommodation response.
Why the other options are incorrect:
A. The pupils remain the same size when focusing on a near object — Pupils should constrict, not remain the same size, during accommodation. No change in pupil size indicates an absent or abnormal accommodation response.
C. The pupils dilate when the nurse shines a light from the side — Pupil dilation in response to light from the side describes the consensual light reflex test, not accommodation assessment.
D. The eyes move together when the nurse shines a light directly into one eye — This describes testing for the consensual pupillary light reflex and corneal light reflex, not accommodation.
Which of the following is the most effective way to protect the lungs from exposure to harmful substances in a high-risk occupational setting?
- Implementing workplace ventilation systems
- Using a portable personal air monitor
- Using a standard surgical mask daily
- Wearing a fitted N95 respirator
Explanation
Correct Answer: D) Wearing a fitted N95 respirator
A properly fitted N95 respirator provides the highest level of personal respiratory protection by filtering at least 95% of airborne particles, including fine dust, chemical particles, and infectious agents. It creates a tight seal around the face, preventing inhalation of harmful substances directly at the source of exposure.
Workplace ventilation systems help reduce overall airborne contaminant levels but do not provide individual protection when direct exposure occurs. A portable air monitor detects harmful substances but does not provide any protection.
A standard surgical mask is not designed to filter fine particles and does not create an adequate seal, making it insufficient for high-risk occupational environments.
The nurse auscultates an abnormal heart sound caused by turbulent blood flow through the cardiac valves. How would the nurse document this finding?
- Hypertrophic cardiomyopathy
- Pleural friction rub
- Murmur
- Congestive heart failure
Explanation
Correct Answer: C) Murmur
A cardiac murmur is defined as an abnormal heart sound produced by turbulent blood flow through the cardiac valves or abnormal communications within the heart. Murmurs are documented based on their timing, intensity, location, radiation, quality, and pitch.
Hypertrophic cardiomyopathy is a structural cardiac diagnosis, not a specific auscultatory finding to be documented. A pleural friction rub is a respiratory sound caused by inflamed pleural surfaces rubbing together, not a cardiac valve sound.
Congestive heart failure is a clinical diagnosis and not an auscultatory finding. Therefore, the correct term to document turbulent blood flow through the cardiac valves is a murmur.
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Measure the client's blood pressure manually instead of using the electronic machine.
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Let the client rest and document the reading from the last time the blood pressure was taken.
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Return in 30 minutes and assess the blood pressure when the client is calmer.
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Proceed in assessing the client's blood pressure and document the findings in the client's chart.
Explanation
Correct Answer: (C) Return in 30 minutes and assess the blood pressure when the client is calmer
Emotional stress and anger significantly elevate blood pressure, making any reading taken immediately after an argument inaccurate and not reflective of the client's true baseline. Allowing the client time to calm down before reassessing ensures a more accurate and clinically meaningful reading.
Why the other options are incorrect:
A. Measure the client's blood pressure manually instead of using the electronic machine — The method of measurement does not address the underlying issue of emotional arousal skewing the result.
B. Let the client rest and document the reading from the last time the blood pressure was taken — Documenting an old reading without obtaining a current assessment is not clinically appropriate or accurate.
D. Proceed in assessing the client's blood pressure and document the findings in the client's chart — Proceeding immediately would yield an artificially elevated reading due to the emotional stress, leading to potentially unnecessary interventions.
A client is being admitted with a diagnosis of pneumonia. Which assessment finding should the nurse address first?
- Oral temperature is 99.2 F
- Respirations are 24 and labored
- Blood pressure supine is 134/78
- Heart rate is 105
Explanation
Correct Answer: B) Respirations are 24 and labored
Using the ABCs (Airway, Breathing, Circulation) framework, breathing takes priority over other assessment findings. Respirations of 24 that are labored indicate tachypnea and increased work of breathing, which is a direct threat to oxygenation and requires immediate intervention.
A low-grade temperature of 99.2°F is expected with pneumonia and is not immediately life-threatening. A blood pressure of 134/78 is only mildly elevated and does not require immediate intervention.
A heart rate of 105 indicates mild tachycardia, which is likely a compensatory response to hypoxia or fever, but addressing the respiratory compromise first will help resolve the tachycardia.
Client Profile: Name: Peter List | Provider: T. Wallace, MD | Code Status: Full Code | Allergies: None Known | Age: 59 years | Weight: 66.36 kg (145.9 lbs)
Vital Signs (06/04/XX at 1705): Temperature: 108.6°F (42.3°C) temporal Heart Rate: 90 Respirations: 16 Blood Pressure: 181/98 right arm
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Blood pressure
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Heart rate
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Temperature
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Oxygen saturation
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Respiratory rate
Explanation
Correct Answer: (A, C) Blood pressure and Temperature
The temperature of 108.6°F (42.3°C) is a critical and potentially fatal finding. Normal oral temperature ranges from 97.8°F to 99.1°F. A temperature of 108.6°F is consistent with hyperpyrexia and is incompatible with life if sustained. This value is so extreme that it is most likely a measurement or documentation error by the UAP and must be reassessed immediately using a calibrated thermometer with correct technique before any clinical decisions are made.
The blood pressure of 181/98 mm Hg is significantly elevated and falls within the Stage 2 hypertension range. While hypertension can be a genuine clinical finding, a reading this high in a client with no previously documented history warrants reassessment to rule out measurement error such as incorrect cuff size, improper positioning, or equipment malfunction before notifying the provider and initiating interventions.
Why the other options are incorrect:
B. Heart rate of 90 — A heart rate of 90 beats per minute falls within the normal adult range of 60 to 100 beats per minute. This value does not require reassessment.
D. Oxygen saturation — Oxygen saturation was not documented in the charted vital signs. Its absence may warrant assessment if clinically indicated, but it cannot be identified as a value requiring reassessment based on the data provided.
E. Respiratory rate of 16 — A respiratory rate of 16 breaths per minute is within the normal adult range of 12 to 20 breaths per minute and does not require reassessment.
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Sexual history
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History of smoking
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Mood changes
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Dietary preferences
Explanation
Correct Answer: (B) History of smoking
Smoking is a well-documented risk factor for several serious eye conditions including cataracts, macular degeneration, and optic nerve damage. Including smoking history in an eye health assessment is clinically relevant and directly impacts ocular health outcomes.
Why the other options are incorrect:
A. Sexual history — Sexual history is not a standard component of an eye health assessment unless a specific sexually transmitted infection with ocular manifestations is being investigated.
C. Mood changes — Mood changes are relevant to mental health assessments and neurological evaluations but are not a standard part of an ocular health history.
D. Dietary preferences — While certain nutritional deficiencies can affect eye health, dietary preferences are not a priority component of a standard ocular health history compared to smoking history.
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