A patient arrives at the emergency department following a gunshot wound to the abdomen. He is unresponsive and has cool, clammy skin. Paramedics were unable to initiate a peripheral IV and the patient's abdominal wound is bleeding briskly. The nurse bases emergency interventions on which priority patient problems?
1. Decrease in cardiac output
2. Deficit in fluid volume
3. Increased risk for development of shock
4. Breathing problem disturbance
5. Decreased cerebral blood flow
1, 2, 3, 5
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When preparing to insert an IV, the nurse reviews the client history to determine if there are sites that have been affected by preexisting conditions
Conditions that may limit available veins include:(Select all that apply) Standard Text: Select all that apply. 1. Pregnancy 2. Fluid overload 3. CVA 4. Orthopedic surgery 5. Dialysis shunt
An elderly patient with community-acquired pneumonia has been admitted to the CCU. What nursing action will improve the patient's chances of survival?
A) Obtain blood and sputum cultures on admission and 2 days after admission. B) Initiate intravenous antibiotic therapy within 8 hours after admission. C) Administer intravenous antibiotics for 7 full days. D) Initiate antibiotics only after culture results are known.
Primary intention has a marked advantage over other phases of wound healing because:
a. healing is rapid. b. healing rarely becomes infected. c. minimal scarring results. d. healing is painless.
The nurse is reviewing data collected from a client for cues. How should the nurse use critical thinking skills when analyzing the cues?
a. Select interventions. b. Plan for the client's discharge. c. Identify any patterns. d. Determine which information is true or incorrect.