You are the preceptor for an RN who is undergoing orientation to the intensive care unit. The RN is providing care for a patient with ARDS who has just been intubated in preparation for mechanical ventilation. You observe the nurse perform all of these actions. For which action must you intervene immediately?
a. Assessing for bilateral breath sounds and symmetrical chest movement
b. Auscultating over the stomach to rule out esophageal intubation
c. Marking the tube 1 cm from where it touches the incisor tooth or nares
d. Ordering a chest radiograph to verify that tube placement is correct
Answer: c. Marking the tube 1 cm from where it touches the incisor tooth or nares
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She has demonstrated appropriate technique with medication administration and wound care. The priority nursing diagnosis is: 1. Knowledge Deficient related to home care. 2. Family Processes, Altered related to hospitalization. 3. Parental Anxiety related to care of the child at home. 4. Infection, risk for related to presence of healing wounds.
A client is having chest pain. To distinguish between an acute myocardial infarction (MI) and angina that may be due to other causes,
which of the following diagnostic tests would the nurse expect to be ordered for this client? (Select all that apply). a. troponin I d. CD4 b. CPK e. cholesterol c. CA 125 f. troponin T cardiac-specific
A patient who moved to the United States from Italy comes to the clinic for medical care
The patient has been in this country for several years and has adopted some elements of her new country. Yet she still retains some customs from her homeland. This patient is experiencing: 1) Assimilation. 2) Socialization. 3) Acculturation. 4) Immigration.
The fetus of a patient who is 30 weeks pregnant is failing to thrive in utero. The health care provider wants to deliver the fetus through cesarean birth today. The patient asks why this approach is preferred over a vaginal delivery
What should the nurse respond to the patient? A) "You will have reduced pain afterward.". B) "There's not an advantage; it's just more convenient.". C) "Cesarean birth allows the placenta to deliver easier.". D) "Cesarean birth will reduce pressure on the immature head.".