A young adult patient who is receiving antibiotics for an infected leg wound has a temperature of 101.8° F (38.7° C). Which action by the nurse is most appropriate?
a. Apply a cooling blanket.
b. Notify the health care provider.
c. Give the prescribed PRN aspirin (Ascriptin) 650 mg.
d. Check the patient's oral temperature again in 4 hours.
ANS: D
Mild to moderate temperature elevations (less than 103° F) do not harm the young adult patient and may benefit host defense mechanisms. The nurse should continue to monitor the temperature. Antipyretics are not indicated unless the patient is complaining of fever-related symptoms. There is no need to notify the patient's health care provider or to use a cooling blanket for a moderate temperature elevation.
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A patient being treated for increased intracranial pressure (ICP) from a traumatic brain injury demonstrates an increase in pressure with minimal care activity. What instruction should the nurse provide the nursing student assisting with care for this patient?
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A localized protective reaction of tissue to irritation, injury, or infection that is characterized by pain, redness, and swelling is
A) immune response. B) exacerbation. C) inflammation. D) progression.
The nurse is teaching a client who has been placed on a loop diuretic and requires a potassium supplement. What should the nurse include in the teaching session?
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