The nurse is caring for a patient admitted with a gastrointestinal bleed who is in the compensatory stage of shock. What is an early sign that accompanies initial shock?
A) Increased urine output
B) Increased heart rate
C) Hyperactive bowel sounds
D) Cool, clammy skin
Ans: D
Feedback: In the compensatory stage of shock, the body shunts blood from the organs, such as the skin and kidneys, to the brain and heart to ensure adequate blood supply. As a result, the patient's skin is cool and clammy. Also, in this compensatory stage, blood vessels vasoconstrict, the heart rate increases, bowel sounds are hypoactive, and the urine output decreases.
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When assessing the musculoskeletal system of an older client, it would be important for the nurse to report which finding?
1. Client complains of stiffness and mild pain in the knee joints. 2. Client complains of numbness in the hands. 3. Client is unable to fully extend arms about the head. 4. Crepitus is heard when bending the knee.
The nurse utilizes the data from the interview to complete which step of the nursing process?
1. assessment 2. diagnosis 3. implementation 4. evaluation
The nurse is preparing a report on the number of births by three service providers at the facility (certified nurse-midwives, family practitioners, and obstetricians). This is an example of:
1. Inferential statistics. 2. Descriptive statistics. 3. Evidence-based practice. 4. Secondary use of data.
A nurse feels threatened by her manager who recently cornered her in an empty room and angrily berated her for her slow pace of nursing care. What action should the nurse take first in response to this abusive behavior?
A) Enlist the help of some trusted colleagues and meet with the manager as a group. B) Contact the state board of nursing and ask for advice and assistance. C) Draft a written complaint for submission to her manager's supervisor. D) Confront the manager during a private meeting.