The nurse is caring for a patient who has septic shock. Which assessment finding is most important for the nurse to report to the health care provider?
a. Blood pressure (BP) 92/56 mm Hg
b. Skin cool and clammy
c. Oxygen saturation 92%
d. Heart rate 118 beats/minute
ANS: B
Because patients in the early stage of septic shock have warm and dry skin, the patient's cool and clammy skin indicates that shock is progressing. The other information will also be reported, but does not indicate deterioration of the patient's status.
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a. scratch out the error. b. apply correction fluid. c. erase the error completely. d. draw a single line through the error.
Excessive anxiety during labor heightens the woman's sensitivity to pain by increasing:
a. muscle tension. b. blood flow to the uterus. c. the pain threshold. d. rest time between contractions.
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