Which of the following assessment findings would suggest to the home health nurse that the patient is developing congestive heart failure?

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Question 1 of 5

Which of the following assessment findings would suggest to the home health nurse that the patient is developing congestive heart failure?

Correct Answer: A

Rationale: Orthopnea is a common symptom of congestive heart failure. It is defined as difficulty in breathing when lying flat, which improves when sitting up or standing. This occurs due to the redistribution of blood in the body when changing positions. As fluid accumulates in the lungs in congestive heart failure, lying down increases pressure on the chest and impairs breathing. Therefore, orthopnea is a significant assessment finding that would suggest to the home health nurse that the patient is developing congestive heart failure. Fever, weight loss, and calf pain are not typically associated with congestive heart failure.

Question 2 of 5

Mr. Boy, a 65-year old man, has been admitted wth severe flame burns resulting from smoking in bed. The nurse can expect his room environment to include:

Correct Answer: B

Rationale: Mr. Boy, who suffered severe flame burns from smoking in bed, would require specialized care in a burn unit. In such units, patients like Mr. Boy are typically placed in semi-private rooms. This setting allows for close monitoring, infection control, and privacy for the patient to receive specialized care. Semi-private rooms also facilitate the management of burn injuries, including wound care, dressing changes, and overall patient care. Additionally, the environment in a semi-private room helps in preventing the spread of infections and ensures that the patient's specific care needs are met effectively.

Question 3 of 5

The nurse is developing a teaching plan for a client diagnosed with diabetes insipidus. The nurse should include information about which hormone lacking in clients with diabetes insipidus?

Correct Answer: A

Rationale: Clients with diabetes insipidus lack antidiuretic hormone (ADH), also known as vasopressin. ADH plays a crucial role in regulating the amount of water reabsorbed by the kidneys, thus maintaining the body's water balance. In diabetes insipidus, there is a deficiency or decreased response to ADH, leading to excessive urine production and consequent dehydration if not managed properly. Therefore, understanding the role and function of ADH is essential for the nurse to include in the teaching plan for a client diagnosed with diabetes insipidus.

Question 4 of 5

For the first 72 hours thyroidectomy surgery, the nurse would assess the client for Chvostek's sign and Trousseau's sign because they indicate which of the following?

Correct Answer: A

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Question 5 of 5

Which of the following outcomes would indicate successful treatment of diabetes insipidus?

Correct Answer: A

Rationale: Successful treatment of diabetes insipidus is indicated when the patient's excessive urination (polyuria) and thirst (polydipsia) are controlled. One of the primary goals of treatment is to achieve fluid balance by reducing urine output and, consequently, decreasing the excessive thirst. When the fluid intake is less than 2,500mL, it suggests that the patient's excessive thirst has decreased, indicating successful management of the condition. Monitoring and managing fluid intake are crucial in the treatment of diabetes insipidus to prevent dehydration and electrolyte imbalances. A lower fluid intake is a positive indicator that the treatment is effectively addressing the increased urine output characteristic of diabetes insipidus.

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