The nurse is preparing to assess a client for heaves. Which location should the nurse palpate?
A. Fourth intercostal space, left sternal border.
B. Second intercostal space, left sternal border.
C. Fifth intercostal space, midaxillary line.
D. Second intercostal space, right sternal border.
Answer: D
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The nurse is reviewing the client's serum electrolyte laboratory results and finds the following: sodium 138, chloride 102, potassium 3.9, calcium 8.8, and magnesium 2.7. The nurse attributes the electrolyte balance to which of the following?
1. Missing doses of diuretics 2. Excessive use of antacids 3. Improper use of potassium supplements 4. Excessive salt intake
The cardiologist just informed a patient that he has a reentry circuit in the electrical conduction system in his heart. This arrhythmia is called Wolff-Parkinson-White (WPW) syndrome
After the physician has left the room, the patient asks the nurse to explain this to him. Which of the following statements most accurately describes what is happening? A) "This means that the SA node (which is the beginning of your heart's electrical system) has been damaged and is no longer functioning normal." B) "You must have a large clot in one of your arteries that supply oxygenated blood to the special conduction cells in your heart." C) "There is an extra, abnormal electrical pathway in the heart that leads to impulses traveling around the heart very quickly, in a circular pattern, causing the heart to beat too fast." D) "For some reason, your electrical system is not on full charge, so they will have to put in new leads and a pacemaker to make it work better."
A patient who has suffered a spinal cord injury at C4 is experiencing a sudden change in condition. His BP is 186/101; heart rate is 45; and he is profusely sweating and complaining of "not feeling right." The nurse should
A) call a "Code Blue." B) page physician stat. and ask for an antihypertensive medication. C) palpate his bladder for overdistention. D) place his bed flat and elevate the foot of the bed.
During the assessment of a patient with a major psychiatric disorder, the nurse learns that the patient's mother has the same disorder. What domain is the nurse using to assess the patient?
1. Cultural 2. Biological 3. Sociological 4. Psychological