The nurse is caring for a client who has just been brought to the postanesthesia care unit (PACU) after surgery. The client's oxygen saturation is 92% and his hemoglobin is 14 g/dL. What is the nurse's first action?
a. Assess the client's pain response.
b. Determine whether the client is alert and oriented.
c. Increase oxygen and auscultate lung sounds.
d. Assess vital signs and temperature.
C
Oxygen saturation is the most definitive assessment finding for whether or not the client is ade-quately oxygenated. However, because oxygen saturation is based on the amount of hemoglobin in the blood, this indicator needs to be evaluated, in addition to the saturation. If a client has low hemoglobin, even if the percentage of saturation is high, the client is still underoxygenated. Oxygen should be increased and further respiratory assessment performed.
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Patient outcomes should be written as
a. broad statements without end points. b. realistic, measurable statements. c. a means of increasing patient knowledge. d. follow-ups to patient goals.
Carrie, the manager of the pediatric floor, is being evaluated by her director. Carrie set goals last year such as increasing patient satisfaction on her unit by 20% and decreasing staff turnover by 10%
Carrie's performance appraisal today is based on how well she achieved those goals. This type of performance appraisal is called: a. just culture. b. peer review. c. 360-degree evaluation. d. management by objectives.
A client is admitted with a ruptured tympanic membrane in the right ear. This may result in a hearing loss in the right ear because the main function of the tympanic membrane is to:
1. Vibrate with sound waves. 2. Separate the outer and inner ear. 3. Cover the eustachian tube. 4. Cover the mastoid process.
Which factors which would alert the nurse to negative/dysfunctional family dynamics?
a. Aging of family members b. Chronic illness of a family member c. Disability of a family member d. Intimate partner violence