The client with heart failure is experiencing respiratory difficulty. Which is the nurse's best intervention?
A. Place the client in the high-Fowler's position.
B. Suction the client.
C. Auscultate the client's heart and lungs.
D. Place the client on fluid restriction.
A
Placing a client in the high-Fowler's position with pillows under each arm can maximize chest expansion and improve oxygenation.
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An emergency department (ED) manager wants to improve care for victims of sexual assault. What action by the manager is best?
a. Designate a private area of the ED for examinations. b. Establish a SART team for the department. c. Ask nurses to volunteer to be advocates for these patients. d. Have victims examined immediately, rather than waiting their turn.
The nurse is administering warfarin (Coumadin) to a patient with deep vein thrombophlebitis. Which laboratory value indicates warfarin is at therapeutic levels?
A) Partial thromboplastin time (PTT) 1½ to 2 times the control B) Prothrombin time (PT) 1½ to 2 times the control C) International normalized ratio (INR) of 3 to 4 D) Hematocrit of 32%
A senior nursing student is working on a community health project for the local homeless shelter. There are several indigent men who come to the shelter in cold weather to sleep for the night
The student nurse knows that these men do not bathe on a regular basis. One of the men has been sick several times recently with skin infections. Which of the following is the best way for the student nurse to explain the importance of personal hygiene to this individual? a. "You don't have to shower every day. You only need to take a shower when you feel like you're going to be sick." b. "Take a shower. If you don't take a shower, you will continue to get sick." c. "Showering regularly will remove germs that cause skin infections. What do you think we should do about these skin infec-tions of yours?" d. "Showering with warm water is enough to wash away bacteria. Soap is not needed if you don't like it."
What is the major reason for using a treatment to lower body temperature after cardiac arrest to promote better neurological recovery?
a. Hypothermia decreases the metabolic rate by 7% for each decrease of 1° C. b. Lower body temperatures are beneficial in patients with low blood pressure. c. Temperatures of 40° C may reduce neurological impairment. d. The lower body temperature leads to decreased oxygen delivery.