The nurse is assessing a client who is 7 months pregnant. The nurse would document which of the following cardiac findings as normal in this client?
1. Increased systolic and diastolic blood pressures when standing
2. Point of maximal impulse palpated at fourth intercostal space and left of midclavicular line
3. Bradycardia
4. Diastolic murmur
2
Rationale 1: At this stage of the client's pregnancy, the blood pressure should be normal when compared to pre-pregnancy values.
Rationale 2: During pregnancy, the heart is displaced to the left and upward and so it would be normal to palpate the point of maximal impulse left of the midclavicular line at the fourth intercostal space.
Rationale 3: The pregnancy usually results in an increase in the client's heart rate from pre-pregnancy values.
Rationale 4: It is not normal to find a diastolic murmur.
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The nursing administration of a health care facility wishes to use Stetler's hierarchy of evidence levels as the basis for its choice of evidence-based practice interventions
What weaknesses in this hierarchy should the group be aware of as it continues in this work? Standard Text: Select all that apply. 1. Few randomized clinical trials have been done in nursing. 2. Nurses do not have the expertise to use these levels of evidence. 3. There are numerous variables in the daily provision of nursing care. 4. The levels do not consider quality improvement initiatives. 5. It is difficult for nursing research to reach the first or second level of evidence.
A 77-year-old woman who lives with her husband has undergone cardioversion twice in the past several months for the treatment of atrial fibrillation
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A woman gives birth to a newborn at 36 weeks' gestation. She tells the nurse, "I'm so glad that my baby isn't premature.". Which response by the nurse would be most appropriate?
A) "You are lucky to have given birth to a term newborn.". B) "We still need to monitor him closely for problems.". C) "How do you feel about delivering your baby at 36 weeks?" D) "Your baby is premature and needs monitoring in the NICU.".