A patient is being admitted to the intensive care unit after cardiac surgery. Which nursing actions should the nurse include in this patient's plan of care? (Select all that apply.)
a. Note any patient shivering.
b. Assess breath sounds every shift.
c. Assist in head-to-toe data collection.
d. Place the patient in a cool environment.
e. Connect the patient to a cardiac monitor.
f. Palpate chest and neck for signs of crepitus.
ANS: A, B, C, E, F
All actions should be performed for this patient except for D because the patient will likely be cool from surgery and need warming.
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A patient is adapting to the use of a hearing aid for the first time. What is the most common challenge experienced by a patient with hearing loss who is adapting to using a hearing aid for the first time?
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During a postpartum examination of a client who delivered an 8-pound newborn 6 hours ago, the nurse assesses the following: fundus firm and at the umbilicus, and moderate lochia rubra with a steady trickle of blood noted from the vagina
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