a patient with idiopathic pulmonary arterial hypertension ipah is receiving nifedipine procardia which assessment would best indicate to the nurse th

NCLEX-RN

NCLEX RN Prioritization Questions

1. A patient with idiopathic pulmonary arterial hypertension (IPAH) is receiving nifedipine (Procardia). Which assessment would best indicate to the nurse that the patient's condition is improving?

A. Blood pressure (BP) is less than 140/90 mm Hg.
B. Patient reports decreased exertional dyspnea
C. Heart rate is between 60 and 100 beats/minute
D. Patient's chest x-ray indicates clear lung fields

Correct answer: Patient reports decreased exertional dyspnea

Rationale: The correct answer is for the patient to report decreased exertional dyspnea. In idiopathic pulmonary arterial hypertension (IPAH), exertional dyspnea is a significant symptom indicating disease severity. Improvement in this symptom suggests that the medication, nifedipine, is effective in managing the condition. While nifedipine can affect blood pressure (choice A) and heart rate (choice C), these parameters are not specific indicators for monitoring IPAH improvement. Choice D, clear lung fields on the chest x-ray, does not directly correlate with the effectiveness of therapy for IPAH. Therefore, the most relevant assessment to monitor improvement in a patient with IPAH receiving nifedipine is a decrease in exertional dyspnea.

2. Which of the following conditions most commonly causes acute glomerulonephritis?

A. A congenital condition leading to renal dysfunction.
B. Prior infection with group A Streptococcus within the past 10-14 days.
C. Viral infection of the glomeruli.
D. Nephrotic syndrome.

Correct answer: Prior infection with group A Streptococcus within the past 10-14 days.

Rationale: Acute glomerulonephritis is most commonly caused by the immune response to a prior upper respiratory infection with group A Streptococcus. Glomerular inflammation occurs about 10-14 days after the infection, resulting in scant, dark urine and retention of body fluid. Periorbital edema and hypertension are common signs at diagnosis.

3. Why are subdural hemorrhages more common in the elderly?

A. Increased anticoagulant use
B. Increased risk of falls
C. Brain atrophy
D. Inconsistent care giving

Correct answer: Brain atrophy

Rationale: Subdural hemorrhages are more common in the elderly due to cerebral atrophy resulting from the natural aging process. This atrophy can lead to the stretching of bridging veins, making them more fragile and prone to tearing even with minor trauma. While increased anticoagulant use and a higher risk of falls are common in the elderly, brain atrophy plays a more direct role in the increased incidence of subdural hemorrhages. Inconsistent caregiving, on the other hand, is not a direct cause of subdural hemorrhages but may impact the overall management and outcome of such cases.

4. Which of the following statements best describes postural drainage as part of chest physiotherapy?

A. Tapping on the chest wall to loosen secretions
B. Squeezing the abdomen to increase expansion of the upper chest
C. Using gravity to move secretions in the lung tissue
D. Dilating the trachea to facilitate better release of secretions

Correct answer: Using gravity to move secretions in the lung tissue

Rationale: Postural drainage is a technique used in chest physiotherapy for clients with accumulated lung secretions. It involves positioning the client to utilize gravity in moving secretions from the lungs. Choice A, tapping on the chest wall, describes percussion, not postural drainage. Choice B, squeezing the abdomen, is not a correct description of postural drainage. Choice D, dilating the trachea, is not related to postural drainage but may be associated with airway clearance techniques.

5. Which individual is at greatest risk for developing hypertension?

A. 45-year-old African-American attorney
B. 60-year-old Asian-American shop owner
C. 40-year-old Caucasian nurse
D. 55-year-old Hispanic teacher

Correct answer: 45-year-old African-American attorney

Rationale: African-Americans have a higher risk of developing hypertension compared to other ethnic groups. They tend to develop high blood pressure at younger ages and are more sensitive to salt, which increases their risk of hypertension. Additionally, studies have shown that African-Americans may respond differently to hypertensive drugs. Therefore, the 45-year-old African-American attorney is at the greatest risk for developing hypertension. The other choices do not specify factors that put them at a higher risk for hypertension compared to African-Americans.