Immediately following a liver biopsy, the patient becomes dyspneic, the pulse increases to 100, and no breath sounds can be heard on the affected side. What should the nurse suspect?
a. Peritonitis
b. Pneumothorax
c. Hemorrhage of the liver
d. Pleural effusion
ANS: B
Pneumothorax is a possible complication of paracentesis. The patient's head of the bed should be raised slightly, but kept on the right side. Oxygen should be administered and the assessment reported to the charge nurse and documented.
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A patient has critically low thyroid levels. What symptoms does the nurse expect?
A) Reduced deep tendon reflexes B) Uncontrolled hypertension and hyperthermia C) Tachycardia, tachypnea, and hyperventilation D) Rapid, agitated speech and anxious look
When completing the assessment of an immobilized patient, the most likely place for the nurse to assess edema includes which of the following? (Select all that apply.)
a. Face b. Feet c. Sacrum d. Abdomen e. Legs
A client is scheduled for the "early release" discharge after suffering an STEMI. Which action by the nurse would most facilitate a successful outcome after discharge?
a. Arranging to have all medications delivered to the home b. Referring the client for home health care visits c. Reviewing the client's medications before discharge d. Teaching the client to monitor his/her own blood pressure
The client has been started on Zyflo. The nurse's highest priority intervention while the client is receiving this medication is to monitor:
a. liver enzymes. b. serum glucose. c. calcium level. d. potassium level.