A patient with congestive heart failure and dyspnea may have pulmonary edema, which can cause severe hypertension. Therefore, taking the patient’s blood pressure should be the first action. Monitor BP and central venous pressure (CVP). Hypertension and elevated CVP suggest fluid volume excess and may reflect developing pulmonary congestion, HF.

Option A: Lying flat on the exam table would likely worsen the dyspnea, and the patient may not tolerate it. Maintain chair or bed rest in semi-Fowler’s position during acute phase. Recumbency increases glomerular filtration and decreases production of ADH, thereby enhancing diuresis.
Option B: Blood draws for chemistry and ABG will be required, but not prior to the blood pressure assessment. Investigate reports of sudden extreme dyspnea and air hunger, need to sit straight up, sensation of suffocation, feelings of panic or impending doom.
Option C: The patient may be sent for an xray after initial assessment. Monitor chest x-ray. Reveals changes indicative of resolution of pulmonary congestion. Maintain fluid and sodium restrictions as indicated. Reduces total body water and prevents fluid reaccumulation.

Nitroglycerin is a potent vasodilator and often produces unwanted effects such as headache, dizziness, and hypotension. Headaches can be severe, throbbing, and persistent and may occur immediately after use. Many of these adverse effects are secondary to the hypotensive effects of nitroglycerin. Patients may report symptoms of orthostatic hypotension which manifest as dizziness, weakness, palpitations, and vertigo. Profound hypotension may occur in patients with preload-dependent conditions.

Option A: Patients should be counseled, and the dose titrated, to minimize these effects. The patient should not stop the medication. No currently known antagonist is available to counteract the effect of nitroglycerin. Since the effects are related to venodilation and relative arterial hypovolemia, efforts to increase central fluid volume have proven to be effective.
Option B: Nitroglycerine does not cause bleeding in the brain. Some patients can be more sensitive to the hypotension caused by nitrates, which can result in nausea, vomiting, diaphoresis, pallor, and collapse even at therapeutic doses.
Option D: Headaches are one of the unwanted side effects of nitroglycerin. Syncope is the most dangerous adverse effect and can result in falls and their resultant injuries. The risk of syncope significantly increases with the concurrent use of a phosphodiesterase-5 (PDE-5) inhibitor.

Three months after surgery and chemotherapy the patient is likely to be feeling the after-effects, which often includes anemia because of bone-marrow suppression. The side effects of cancer chemotherapy can be acute or prolonged, and may need monitoring. It would require multi-disciplinary monitoring as certain patient populations may be at higher risk for complications. Interventions like exercise, optimizing sleep quality, and behavioral therapies such as relaxation can help fatigue.

Option B: There is no evidence that the patient is immunosuppressed, and fatigue is not a typical symptom of immunosuppression. Common toxicities associated with such agents include myelosuppression, nausea, vomiting, GI side effects, mucositis, alopecia, sterility, infertility, and infusion reactions. Furthermore, there is an increased risk of infections due to immunosuppression.
Option C: Patients undergoing chemotherapy usually need strong emotional support, and they are going through anxiety, depression, and anticipatory grief from the expected side effects of the drugs. Multidisciplinary and interprofessional interventions at various stages of their treatment regimen can promote mental health. However, it is not indicated in this stem.
Option D: The information given does not indicate that dehydration is a cause of her symptoms. Chemotherapy-induced nausea and vomiting treatment options include prochlorperazine, haloperidol, metoclopramide, lorazepam, dexamethasone, ondansetron, granisetron, dolasetron, palonosetron, dronabinol, aprepitant, fosaprepitant, netupitant. palonosetron has a longer half-life, better efficacy, and higher binding affinity than granisetron.

Normal hemoglobin values range from 11.5-15.0. This vegetarian patient is mildly anemic. When food is prepared in iron cookware its iron content is increased. Anemia is defined as hemoglobin below two standard deviations of the mean for the age and gender of the patient. Iron is an essential component of the hemoglobin molecule. The most common cause of anemia worldwide is iron deficiency, which results in microcytic and hypochromic red cells on the peripheral smear.

Option A: The client is mildly anemic. The cause of iron-deficiency anemia varies based on age, gender, and socioeconomic status. Iron deficiency may result from insufficient iron intake, decreased absorption, or blood loss. Iron-deficiency anemia is most often from blood loss, especially in older patients.
Option B: Mild anemia does not require that animal sources of iron be added to the diet. Many non-animal sources are available. Dietary sources of iron are green vegetables, red meat, and iron-fortified milk formulas. It may also be seen with low dietary intake, increased systemic requirements for iron such as in pregnancy, and decreased iron absorption such as in celiac disease.
Option D: Coffee and tea increase gastrointestinal activity and inhibit absorption of iron. The iron in food comes from two sources: animals and plants. Iron from animal sources is known as heme iron and is found in meat and fish. Iron from plants is known as nonheme iron, and is found in certain vegetables and in iron-fortified foods such as breakfast cereals. Heme iron is better absorbed by the body than non heme iron.

Transfusion reaction is most likely during the first 15 minutes of infusion, and a nurse should be present during this period. The nurse remains with the client, observing signs and symptoms and monitoring vital signs as often as every 5 minutes. Meticulously verifying patient identification beginning with type and crossmatch sample collection and labeling to double-check blood product and patient identification prior to transfusion.

Option A: Transfusion reaction typically starts in the first 15 minutes of infusion. Beginning transfusion slowly ( 1 to 2 mL/min) and observing the patient closely, particularly during the first 15 minutes (severe reactions usually manifest within 15 minutes after the start of transfusion).
Option B: PRBCs should be infused through a 19g or larger IV catheter to avoid slow flow, which can cause clotting. Transfusing blood within 4 hours, and changing blood tubing every 4 hours to minimize the risk of bacterial growth at warm room temperatures.
Option C: PRBCs must be flushed with 0.45% normal saline solution. Other intravenous solutions will hemolyze the cells. Upon detection of any signs or symptoms of reaction, stop the transfusion immediately and notify the physician. Disconnect the transfusion set-but keep the IV line open with 0.9% saline to provide access for possible IV drug infusion.