During a physical assessment, the nurse notes a patient has profuse secretions of sweat. The nurse should document that the patient is experiencing:
a. dyspnea.
b. cyanosis.
c. diaphoresis.
d. ecchymosis.
C
Diaphoresis is the secretion of sweat, especially the profuse secretion associated with an elevated body temperature, physical exertion, exposure to heat, and mental or emotional stress.
You might also like to view...
The patient with a colostomy has been incorrectly applying his ostomy appliance. The continuous contact with liquid stool has caused a skin wound around the ostomy. The nurse assesses bleeding and purulent drainage that has extended into the dermis
How will the nurse classify and document this contaminated wound? a. Acute, full-thickness, open b. Chronic, partial-thickness, closed c. Acute, partial-thickness, closed d. Chronic, unstageable, open
Nursing interventions appropriate for the client with the nursing diagnosis Imbalanced Nutrition: Less than Body Requirements include:
1. Assisting with changes in diet. 2. Monitoring blood glucose. 3. Providing enteral nutrition. 4. Feeding the client.
A child in the ICU has a cleft palate. The nurse should expect which of the following dysfunctions in this child related to this congenital defect?
A) Nasal regurgitation B) Vomiting C) Diarrhea D) Choking
A 22-year-old college student is devastated to receive word that her recent testing for HIV has come back positive. The patient tearfully admits to the clinic nurse, "This isn't supposed to happen to me
I've got plans for my life, and this changes absolutely everything." What psychosocial nursing diagnosis should the nurse consider when interacting with this patient? A) Altered growth and development related to diagnosis with HIV B) Risk for loneliness related to HIV diagnosis C) Disturbed body image related to diagnosis of HIV D) Moral distress related to HIV diagnosis