The nurse observes two premature atrial contractions (PACs) in 1 minute on a patient's cardiac monitor. The patient is asymptomatic. What action is required by the nurse?
a. Continue monitoring the patient.
b. Take vital signs every 15 minutes.
c. Administer digoxin.
d. Notify the physician.
ANS: A
PACs are usually not dangerous, and often no treatment is required other than correcting the cause if they are frequent, so continue to monitor the patient. It is not necessary to take the other actions at this time.
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The nurse is caring for a very seriously ill patient in the CCU. The family visits sporadically, stays for only a short time, and does not ask many questions. How could the nurse best begin to involve the family in the patient's care?
A) Ask one family member to assist with the patient's bath. B) Encourage family members to stay longer at each visit. C) Focus nursing efforts on the patient's legal next of kin. D) Ask the family to complete the Critical Care Family Needs Inventory.
A 42-year-old male client continues to enter into business deals that cause him to lose large amounts of money. He subsequently seeks mental health care for stress-related disorders
Which characteristic of a successful adult is this client lacking? a. Acceptance of self b. Finding a balance between giving and taking c. Making sound decisions d. Learning from past decisions
The patient with renal insufficiency is aware that renal function depends upon the functional status of nephrons and asks the nurse when she will need to start dialysis based upon loss of nephron function. The nurse responds:
A) "When about 50% of the nephrons are no longer functioning." B) "When about 60% of the nephrons are no longer functioning." C) "When about 70% of the nephrons are no longer functioning." D) "When about 80% of the nephrons are no longer functioning."
The nurse in the postanesthesia care area is concerned that a patient recovering from a subtotal thyroidectomy is experiencing postoperative complications. What findings led the nurse to come to this conclusion?
Select all that apply. 1. hoarse voice 2. restlessness and irritability 3. blood pressure 92/56 mmHg 4. heart rate 116 beats per minute 5. high-pitched, squeaky sound with breathing