The client has a pH of 7.6. Which statements are appropriate based on this pH level?(Select all that apply.)
1. The client should be monitored for nervousness.
2. The client is alkalotic.
3. The client should be monitored for drowsiness.
4. The client is acidotic.
5. The client should be monitored for seizures.
1, 2, 5
Rationale 1: At pH values above 7.45, alkalosis develops, and symptoms of CNS stimulation occur that include nervousness and convulsions.
Rationale 2: At pH values above 7.45, alkalosis develops, and symptoms of CNS stimulation occur that include nervousness and convulsions.
Rationale 3: The client should be monitored for symptoms of CNS stimulation, not CNS depression.
Rationale 4: The pH is alkaline.
Rationale 5: The pH is alkaline and symptoms of CNS stimulation can occur, which include seizures.
Global Rationale: At pH values above 7.45, alkalosis develops, and symptoms of CNS stimulation occur that include nervousness and seizures. The client should be monitored for symptoms of CNS stimulation, not CNS depression.
You might also like to view...
A nurse is caring for a patient with a skin tear. Which of the following is included in this care? Select all that apply
A) Clean the wound with normal saline. B) Clean the wound with hydrogel. C) Cover the wound with a self-adherent dressing. D) Tape the dressing in place to avoid displacement. E) Apply hydrogel before cleansing the wound. F) Wrap the wound with a nonadherent dressing.
The healthcare provider suggests that an older patient with type 2 diabetes mellitus begin a walking program. What should the nurse include when teaching the patient about this program? Select all that apply.
1. Dress in layers. 2. Wear shoes with thick flexible soles. 3. Walk at least three to five times a week. 4. Wear music headset to block noise distractions. 5. Perform warm-up exercises before walking.
Which nursing intervention is vital to the effective management of a psychiatric emer-gency resulting from a patient's experience of extreme despair?
a. Suicide precautions b. Introduction to a support group c. Introducing new coping mechanisms d. Assessment for obsessive-compulsive rituals
M.D. is a 50-year-old woman whose routine mammogram showed a 2.3-× 4.5-cm lobulated mass at the 3
o'clock position in her left breast. M.D. underwent a stereotactic needle biopsy and was diagnosed with infiltrating ductal carcinoma, estrogen receptor positive. The staging workup was negative for distant metastasis. Her final staging was stage IIB. She had a modified radical mastectomy with lymph node dissection. The sentinel lymph node and 4 of 16 lymph nodes were positive for tumor cells. An implanted port was placed during surgery. Describe the biopsy technique used to diagnose M.D.'s cancer.