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The nurse is caring for a client after a coronary artery bypass graft surgery. The client is exhibiting pitting edema of the lower extremities and jugular venous distention with increased central venous pressure. Which condition should the nurse suspect the client is experiencing based on these findings?

A.

Internal bleeding.

B.

Right-sided heart failure.

C.

Left ventricular dysfunction.

D.

Cardiac tamponade.

Answer and Explanation

The Correct Answer is B

A. Internal bleeding typically presents with signs of hypovolemia, such as decreased blood pressure and increased heart rate, rather than pitting edema and jugular venous distention.  

 

B. Right-sided heart failure is characterized by fluid overload, leading to symptoms like pitting edema in the extremities and jugular venous distention, which align with the findings observed in this client.  

 

C. Left ventricular dysfunction primarily results in pulmonary congestion and respiratory distress rather than peripheral edema and jugular venous distention.  

 

D. Cardiac tamponade may present with jugular venous distention, but it usually also involves hypotension and muffled heart sounds, which are not described in this scenario.


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Correct Answer is D

Explanation

A. While obtaining a keyboard designed to limit wrist flexion may be beneficial for ergonomics, it does not specifically address the symptoms or management of Raynaud's syndrome.

B. Taking a multivitamin with vitamin D may not have a direct impact on Raynaud's syndrome and is generally unrelated to the specific concerns of this condition.

C. Keeping hands elevated during breaks does not effectively address the primary concern of temperature regulation that affects Raynaud's syndrome.

D. Using a space heater is a practical measure that can help keep the workspace warm, thereby reducing the likelihood of Raynaud's attacks, which are triggered by cold temperatures and stress.

Correct Answer is B

Explanation

A. A soft diet may not provide sufficient fiber, which is essential for managing diverticulosis and preventing complications such as diverticulitis.

B. A high fiber diet helps to bulk up stool and promotes regular bowel movements, reducing the risk of complications associated with diverticulosis. Increased fluid intake is also essential to help fiber work effectively in the digestive system.

C. While sitting up after meals can aid digestion, it is not a primary dietary instruction for managing diverticulosis.

D. A bland diet may not be necessary; the focus should be on increasing fiber intake rather than avoiding specific flavors or spices unless they cause discomfort.

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