You are precepting a new graduate nurse in the ICU. You are collaborating in the care of a patient who is receiving large volumes of crystalloid fluid to treat hypovolemic shock
In light of this intervention, for what sign would you teach the new nurse to monitor the patient?
A) Hypothermia
B) Bradycardia
C) Coffee ground emesis
D) Pain
Ans: A
Feedback:
Temperature should be monitored closely to ensure that rapid fluid resuscitation does not precipitate hypothermia. IV fluids may need to be warmed during the administration of large volumes. The nurse should monitor the patient for cardiovascular overload and pulmonary edema when large volumes of IV solution are administered. Coffee ground emesis is an indication of a GI bleed, not shock. Pain is related to cardiogenic shock.
You might also like to view...
Which one of the following residents of a long-term care facility is most likely exhibiting signs and symptoms of depression?
A) Mrs. L, age 79, who has withdrawn from her regular bridge games and no longer returns calls to her friends. B) Mr. U, age 76, whose neighbors have stated that he has become progressively more forgetful in the last several weeks. C) Ms. K, age 73, who has visited her primary care physician with complaints of palpitations and labored breathing accompanied by feelings of doom. D) Mrs. D, age 82, who is frequently tearful following the death of her husband 4 days prior.
Depression is often caused by decreases in the neurotransmitters ____________________ and _____________________
Fill in the blank(s) with correct word
Long-term monitoring of patients who are taking carbamazepine includes:
1. Routine troponin levels to assess for cardiac damage 2. Annual eye examinations to assess for cataract development 3. Monthly pregnancy tests for all women of childbearing age 4. Complete blood count every 3 to 4 months
What is the highest priority nursing intervention for clients taking anthelmintics?
a. Instruct the client that daily stool specimens must be collected. b. Inform the client that the pathogens are spread via blood. c. Instruct the client to take baths and not showers. d. Alert the client to avoid operating a car or machinery due to drowsiness.