A client with dehydration is being administered IV fluids. During her rounds, the nurse noticed that the skin immediately surrounding the IV site was reddish in color and showing signs of inflammation
The nurse recognizes that what phenomenon is likely responsible?
A) Phlebitis
B) Thrombus formation
C) Pulmonary embolus
D) Air embolism
Ans: A
The nurse should record that the client has phlebitis, which is an inflammation of the vein. Thrombus formation is a situation in which there is a stationary blood clot. Pulmonary embolus is a situation in which the blood clot travels to the lung. Air embolism is a bubble of air traveling within the vascular system.
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The nurse planning a teaching program for a client about postoperative care after a thoracotomy approach to an esophagomyotomy would include information about
a. application of a Hemovac. b. drainage from a T tube. c. insertion of a Blakemore tube. d. presence of closed-chest drainage.
A client with a spinal cord injury was given methylprednisolone in the emergency department. The nurse realizes this medication was provided in order to:
1. Cause an increase in blood glucose level. 2. Improve the ability to be adequately ventilated. 3. Prevent cord damage from ischemia and edema. 4. Improve the level of consciousness.
An appropriate technique for the nurse to implement for the patient on isolation precautions is to:
a. double-bag all disposable items and linens. b. put another gown over the one worn if it has become wet. c. place specimen containers in plastic bags for transport. d. hand items to be reused directly to a nurse standing outside the room.
A nurse is reading an article about a young girl who developed gastrointestinal symptoms from a hair ball because of a ritual that she engaged in. The girl would pull out hair over several hours to relieve tension and anxiety and then eat the hair
The nurse most likely is reading an article about which of the following? A) Kleptomania B) Trichotillomania C) Pyromania D) Intermittent explosive disorder