The nurse suspects that patient is developing sepsis. Which findings did the nurse use to come to this conclusion? (Select all that apply.)
a. Tachycardia
b. Hypotension
c. Hypertension
d. Mental confusion
e. Increased capillary refill
f. Hyperactive bowel sounds
ANS: A, B, C, D
There can be an increase in fever, elevated white blood cell count, decreased blood pressure, mental confusion, tachycardia, and shock with sepsis. E. F. Bowel sounds and capillary refill would be decreased.
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A nurse notes new drug orders for a patient who is already getting several medications. Which of the following is the most important consideration when preparing to administer the new drugs?
A) How the patient will feel about new medications added to her drug therapy B) Possible drug–drug interactions that might occur C) Any special nursing considerations that the nurse must be aware of D) If generic preparations of the drugs can be used
Postoperative nursing measures to prevent the development of deep vein thrombosis, thrombophlebitis, and pulmonary embolism include which of the following?
a. using an alternating pressure pad on the bed b. administering antibiotics every 12 hours as ordered c. massaging the calves of the legs for complaints of "cramping" d. performing postoperative leg exercises each hour
A nurse, after several years of medical-surgical experience, decides that she wants to specialize in another aspect of nursing care. She looks to set up a career vision statement that will begin the process of finding the ideal nursing position
The ideal professional nursing career vision statement would include nursing-related passions. Which of the following human life transitions may cause revisions in the career vision statement based on a mental-health status change? A) Reduced child-care responsibilities B) Position that requires less physical exertion C) Re-enter clinical practice because of a change in marital status D) Leave a position to stay home with children
The nurse is teaching a patient who will begin taking warfarin (Coumadin) for atrial fibrillation. Which statement by the patient indicates understanding of the teaching?
a. "I should eat plenty of green, leafy vegetables while taking this drug." b. "I should take a nonsteroidal anti-inflammatory drug (NSAID) instead of acetaminophen for pain or fever." c. "I will take cimetidine (Tagamet) to prevent gastric irritation and bleeding." d. "I will tell my dentist that I am taking this medication."