Chemical receptors that stimulate inspiration are located in the
a. Brain.
b. Lungs.
c. Aorta.
d. Heart.
ANS: C
Chemical receptors in the aorta send signals to begin the inspiration process. The brain, lungs, and heart all are affected by this chemical reaction.
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When assessing a newborn 1 hour after birth, the nurse measures an axillary temperature of 95.8° F, an apical pulse of 114 beats/minute, and a respiratory rate of 60 breaths/minute. Which nursing diagnosis takes highest priority?
A) Hypothermia related to heat loss during birthing process B) Impaired parenting related to addition of new family member C) Risk for deficient fluid volume related to insensible fluid loss D) Risk for infection related to transition to extrauterine environment
A nurse is working with a small community in rural Africa. There is funding in place to provide low-cost and free contraceptives to women, but the unplanned pregnancy rate has not changed, despite the program being in effect for two years
How should the nurse proceed? A. Withdraw funding from the community, since it does not seem to be effective. B. Provide printed materials on how to properly use condoms and spermicide gels. C. Host a small community focus group with several key women to discuss reasons why the program isn't effective. D. Begin looking for grants to increase funding so they can establish a women's health and family planning center in the community.
The patient's laboratory report today indicates severe hypokalemia, and the nurse has notified the physician. Nursing assessment indicates that heart rhythm is regular. What is the most important nursing intervention for this patient now?
a. Raise bed side rails due to potential decreased level of consciousness and confusion. b. Examine sacral area and patient's heels for skin breakdown due to potential edema. c. Establish seizure precautions due to potential muscle twitching, cramps, and seizures. d. Institute fall precautions due to potential postural hypotension and weak leg muscles.
Explain what information the nursing assistant must communicate to other members of the health care team about the patient.
What will be an ideal response?