A patient is admitted to the critical care unit after a stroke. The patient has an altered level of consciousness and garbled speech
A computed tomography scan is performed to determine the cause of the stroke, and a lumbar puncture is performed for analysis of CSF. Because the patient's speech is garbled, the nurse documents the occurrence of which type of aphasia? a. Fluent c. Expressive
b. Receptive d. Global
C
The area involved in the formulation of verbal speech is the Broca area. Damage to this area results in an expressive or nonfluent aphasia.
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The nurse is caring for a client who is receiving IV therapy at a rate of 10 mL/hour. The 500mL IV bottle was hung at 0900 Monday morning when the IV catheter was initiated. It is now 0900 on Tuesday morning
What nursing action should be taken? A) Discard the remaining IV fluid and hang a new bag. B) Infuse the remaining IV fluid before hanging a new bag. C) Refigure the rate of the IV. D) Discontinue the IV site and restart an IV in the opposite hand.
As part of nursing management of a critically ill patient, orders are written to keep the head of the bed elevated at 30 degrees, awaken the patient from sedation each morning to assess readiness to wean from mechanical ventilation, and implement
oral care protocols every 4 hours. These interventions are done as a group to reduce the risk of ventilator-associated pneumonia. This group of evidence-based interventions is often called a: a. bundle of care. b. clinical practice guideline. c. patient safety goal. d. quality improvement initiative.
A young woman comes in for her annual examination
She reports missing her last two periods but she is confident that she cannot be pregnant, because she took a home pregnancy test and the result was negative. If all of the following were present, which one would positively confirm a pregnancy? A) Chadwick sign B) A fetal heartbeat C) A positive result on hCG D) Changes in the size and shape of the uterus
A ventilated patient is receiving midazolam (Versed) for sedation. The nurse would recognize that the patient is receiving an appropriate dose of midazolam when the patient is:
1. Awake with a respiratory rate of 38 and a heart rate of 132 2. Asleep but withdrawing to noxious stimuli with a heart rate of 80 3. Awake with a heart rate of 124 and attempting to pull out the IV 4. Asleep but awakening to light touch with a heart rate of 72