Which goal would receive the highest priority when caring for the patient with a cervical spine injury?
1. Relieve muscle spasm pain
2. Maintain cervical alignment
3. Support respiratory effort and prevent atelectasis
4. Promote hypothermia
3
Rationale 1: Pain relief is not of the highest priority at this time.
Rationale 2: Cervical alignment is not of the highest priority at this time.
Rationale 3: Due to the risk of airway obstruction and damage to nerves that stimulate respiratory function, ventilation may need to be controlled or assisted. Maintaining oxygenation is the priority at this time.
Rationale 4: Promoting hypothermia is not of the highest priority at this time.
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Why should a nurse tag a victim after assessment in a disaster situation?
A) To know the victim's name B) The tag states the triage category of the victim. C) So that someone else does not duplicate the assessment D) To call for immediate hospitalization
The nurse caring for a patient who suffered an ischemic stroke resulting in disturbed sensory perception is aware that:
A) The patient should be approached on the side where visual perception is intact. B) Attention to the affected side should be minimized. C) The patient should avoid repetitious turning of his head in the direction of the defective visual field in order to minimize shoulder subluxation. D) The patient should be approached on the opposite side of where the visual perception is intact in order to increase perception and vision.
Which of the following statements regarding the effects of homelessness on health is accurate?
1. Peripheral vascular disease and hypertension are lessened by the lifestyle of the homeless. 2. The incidence and virulence of infections are decreasing among the homeless. 3. Trauma is a significant cause of death and disability. 4. Crowded living conditions result in decreased risk for exposure to infections.
You are a nurse at a freestanding cardiac prevention and rehabilitation center. Your new patient in risk-factor modification is B.T., a 41-year-old traveling salesman, who is married and has three children
He tells you that his work does not let him slow down. During a recent evaluation for chest pain, he underwent a cardiac catheterization procedure that showed moderate single-vessel disease with a 50% stenosis in the mid right coronary artery (RCA). He was given a prescription for sublingual (SL) nitroglycerin (NTG), told how to use it, and referred to your cardiac rehabilitation program for sessions 3 days a week. B.T.'s wife comes along to help him with healthy lifestyle changes. You take a nursing history, as indicated in the following. Family History Father died suddenly at age 42 of a myocardial infarction (MI) Mother (still living) had a quadruple coronary artery bypass graft (CABG × 4) at age 52 Past History and Current Medications Metoprolol (Lopressor) 25 mg PO every 12 hours Aspirin (ASA) 325 mg per day PO Simvastatin (Zocor) 20 mg PO every evening Lifestyle Habits Has smoked an average of 11?2 packs of cigarettes per day (PPD) for the past 20 years Drinks an "occasional" beer and "a six-pack every weekend when watching football" Dietary history: High in fried and fast foods because of his traveling Exercise: "I don't have time to take walks." General Assessment White Male Weight 235 lb Height 5 ft, 8 in Waist circumference 48 in Blood Pressure 148/88 mm Hg Pulse 82 beats/min Respiratory rate 18 breaths/min Temperature 98.4 ° F (36.9 ° C) Calculate B.T.'s smoking history in terms of pack-years.