The nurse is assessing a nervous 18-year-old patient who has vital signs of P 120, R 30, and BP 160/90. The patient states that he feels something bad is about to happen
Based on this data alone, how should the nurse identify the patient's level of anxiety?
a.
Mild
b.
Moderate
c.
Severe
d.
Panic
ANS: C
Severe anxiety may be manifested by elevated blood pressure, pulse, and respiratory rate, a feeling of impending danger, and feelings of fatigue.
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A family that has three small children prepares to move an older female parent into their home knowing that she stays up all night, and the nurse helps the family prepare for the change
Which part of planning should the nurse indicate is the family's priority? a. Sharing household responsibilities b. Preparing the house for her arrival c. Helping her use her skills and talents d. Setting limits on nighttime activities
A patient presents at the emergency department in acute respiratory distress. A quick assessment by the triage nurse indicates that the patient experienced difficulty breathing immediately after taking Combivent for the first time
The nurse suspects that the patient may be allergic to what? A) Aspirin B) Penicillin C) Peanuts D) Ragweed pollen
A patient who has been taking lamivudine (Epivir) for 6 months reports reduced sensation in the fingers and toes. What is the nurse's best action?
a. Document the report as the only action. b. Hold the dose and notify the prescriber. c. Remind the patient to continue the drug as usual and take a multiple vitamin dai-ly. d. Reassure the patient that this is an expected drug side effect and to use injury precautions.
For effective restorative care, there must be a smooth progression and flow between caregivers and between shifts.
Answer the following statement true (T) or false (F)