Author Question: A client is admitted with irregular chest pain and shortness of breath. The client complains of ... (Read 104 times)

DyllonKazuo · **on:** Jul 22, 2018

A client is admitted with irregular chest pain and shortness of breath. The client complains of fatigue with activity and has a body mass index (BMI) of 30.5. The nurse diagnosis that might a priority for the client at this time would be:

1. Fear.
2. Ineffective Coping.
3. Fluid Volume Deficit.
4. Imbalanced Nutrition: More than Body Requirements.

Question 2

The nurse is teaching the kindergarten teacher about a 5-year-old with cerebral palsy who will be starting school. The child has a continuous Baclofen pump.

The nurse informs the teacher of possible side effects of this drug, including which of the following? 1. Diarrhea
2. Hypotonia
3. Restlessness
4. Hypertonia

covalentbond · **Reply #1 on:** Jul 22, 2018

Answer to Question 1

4. Imbalanced Nutrition: More than Body Requirements

Rationale:
The client with a BMI of 30.5 is obese. In addition, the client has irregular chest pain and shortness of breath and complains of fatigue with activity. The priority nursing diagnosis for the client at this time would be imbalanced nutrition: more than body requirements. Fear and ineffective coping would be applicable to the client diagnosed with an acute myocardial infarction. There is no evidence that the client has a fluid deficit.

Answer to Question 2

2. Hypotonia

Rationale:
Hypotonia is possible if the child is getting too much Baclofen. Continuous Baclofen infusion does not cause diarrhea. Restlessness is not seen with Baclofen; rather, these children can be drowsy and sleepy. Hypertonia is not seen as a side effect of Baclofen infusion.