Correct Answer: A

Rationale: Given the client's history of type II diabetes mellitus, chronic hypertension, and recent myocardial infarction, the most likely type of shock for the nurse to be prepared to treat in this client is cardiogenic shock. Cardiogenic shock occurs when the heart is unable to pump effectively, leading to inadequate perfusion of vital organs. This can be a complication of myocardial infarction, as damage to the heart muscle can impair its ability to pump blood effectively. Patients with a history of diabetes and hypertension are at increased risk for cardiovascular diseases, such as myocardial infarction, which can lead to cardiogenic shock. Symptoms of cardiogenic shock include hypotension, tachycardia, cool and clammy skin, and altered mental status. Treatment may involve medications to support cardiac function, such as inotropes, and interventions to improve oxygen delivery, such as oxygen therapy and fluid administration.

Correct Answer: A

Rationale: A. Limit the use of over-the-counter medications: This is important because some over-the-counter medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin, can increase the risk of bleeding in individuals taking anticoagulants for the treatment of pulmonary embolism.

Correct Answer: B

Rationale: Pregnancy can put additional strain on the heart, especially in women with pre-existing heart conditions such as heart failure. Therefore, women with stage II heart failure should receive additional monitoring during pregnancy to ensure their heart function remains stable. This may include more frequent check-ups with a healthcare provider, additional tests such as echocardiograms, and potential adjustments to medications as needed to support the health of both the mother and the baby. It is important to closely monitor and manage the heart failure throughout pregnancy to reduce the risk of complications for both the mother and the unborn child.

Correct Answer: A

Rationale: Indomethacin is a medication commonly used to treat patent ductus arteriosus (PDA) in premature infants. PDA is a condition where the ductus arteriosus, a blood vessel that connects the pulmonary artery to the aorta, fails to close after birth. Indomethacin works by inhibiting prostaglandin synthesis, which helps to promote closure of the ductus arteriosus. This medication is often used in premature infants with PDA to prevent complications and improve outcomes. Propranolol is a beta-blocker used for different conditions, antibiotics are used to treat infections, and Prostaglandin E1 is used to maintain ductal patency in certain cardiac conditions where closure is not desired.

Correct Answer: C

Rationale: Following surgery, a patient not voiding for 12 hours raises concerns for urinary retention, especially if the patient was catheterized during the surgical procedure. With urinary retention, the bladder can become distended and palpating for bladder distention can help determine if the patient is experiencing this issue. If the bladder is distended, interventions may be needed to address the urinary retention to prevent complications such as urinary tract infection or bladder distention-related discomfort. The other assessment options (percuting for gastric tympany, auscultating for bowel sounds, inspecting for edema of the urethra) are not as relevant in assessing a patient's urinary status post-surgery.