What is Kehr's sign?
A. Abdominal pain referred to the right shoulder
B. Right quadrant abdominal pain and swelling
C. Abdominal pain referred to the spine
D. Abdominal pain with accompanying rebound tenderness
A
One of the key features of liver trauma is abdominal pain that is increased on deep breathing and is referred to the right shoulder (Kehr's sign).
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As part of the care of a mechanically ventilated patient, the nurse provides oral and subglottic suctioning every 2 hours. What is the best rationale for this nursing action?
A) Stimulates cough and deep breathing B) Reduces pulmonary microbial colonization C) Maintains oral mucosal moisture D) Part of Universal Precautions protocols
Patients on prolonged bed rest are at risk for a deep vein thrombosis. Which information indicates the nurse needs more teaching about the factors in Virchow's triad?
a. One of the factors is loss of integrity of the vessel wall. b. One of the factors is abnormalities of blood flow. c. One of the factors is alterations in blood constituents. d. One of the factors is atrophy of the muscles.
A dying client and family have requested that no attempts be made to resuscitate the client in the event of death. A doctor has written a DNR order. What is the nurse's responsibility if the client dies?
A) Follow his or her own conscience and perform CPR. B) Make no attempt to resuscitate the client. C) Follow a verbal physician's order for a slow code. D) If the client is at home, call 911 and begin CPR.