Which behaviors are most consistent with the clinical picture of a patient who is becoming increasingly aggressive? Select all that apply
a. Pacing
b. Crying
c. Withdrawn affect
d. Rigid posture with clenched jaw
e. Staring with narrowed eyes into the eyes of another
ANS: A, D, E
Crying and a withdrawn affect are not cited by experts as behaviors indicating that the individual has a high potential to behave violently. The other behaviors are consistent with the increased risk for other-directed violence.
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A nurse is caring for a patient who has been admitted with acute cocaine intoxication. Which of the following vital signs would the nurse expect to find initially when assessing the patient?
A) Blood pressure (BP): 98/50, pulse (P): 120, respirations (R): 40 B) BP: 130/88, P: 92, R: 28 C) BP: 150/90, P: 80, R: 16 D) BP: 170/98, P:110, R: 20
A new mother calls the clinic and tells the nurse her toddler has a temperature of 102ºF. How does the nurse explain why the mother should not be alarmed?
A) "A fever is the body's way of fighting an infection and supporting the body's immune system." B) "Neutrophils release pyrogen, a fever-causing substance, which helps act as a catalyst for the body's inflammatory and immune responses." C) "Leukotrienes activated by arachidonic acid attract neutrophils to start the process of fighting inflammation." D) "Inflammation causes the activation of a chemical called Hageman factor that initiates a process to bring more blood to the injured area and allows white blood cells to escape into the tissues."
In nursing, the systematic gathering of information to gain, expand, or validate knowledge about health describes which of the following activities?
A) research B) evaluation C) reporting D) accounting
One bed is available on the inpatient eating disorders unit. Which patient should be admitted? The patient whose weight dropped from:
a. 150 to 100 pounds over a 4-month period. Vital signs: temperature, 35.9° C; pulse, 38 beats/min; blood pressure, 60/40 mm Hg b. 120 to 90 pounds over a 3-month period. Vital signs: temperature, 36° C; pulse, 50 beats/min; blood pressure, 70/50 mm Hg c. 110 to 70 pounds over a 4-month period. Vital signs: temperature 36.5° C; pulse, 60 beats/min; blood pressure, 80/66 mm Hg d. 90 to 78 pounds over a 5-month period. Vital signs: temperature, 36.7° C; pulse, 62 beats/min; blood pressure, 74/48 mm Hg