A patient has sustained a stroke. The speech therapist tells you that the patient cannot control his epiglottis. You know that this patient
a. is at increased risk of aspiration. c. will need a tracheostomy to breathe.
b. will need surgery to close his epiglottis. d. is at risk for a pneumothorax.
A
The epiglottis is responsible for closing over the trachea and preventing entry of swallowed material into the lungs. An inability to control the epiglottis increases the risk of aspiration and may warrant placement of a feeding tube. The patient will still be able to breathe. Closure of the epiglottis over the trachea will occlude the airway.
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An ICU nurse has been approached by a colleague to join the American Association of Critical Care Nurses. The nurse asks the colleague, "Why would I want to join this organization?" Which would be the best response?
1. "It will further your career." 2. "It looks good on your resume." 3. "It will help you to network and enhance your learning." 4. "You have to join before you can obtain critical care certification."
The nurse is obtaining physician orders which include a pulse pressure. The nurse is most correct to report which of the following?
A) The difference between an apical and radial pulse B) The difference between an upper extremity and lower extremity blood pressure C) The difference between the systolic and diastolic pressure D) The difference between the arterial and venous blood pressure
The clinic nurse is preparing a client for a physical and breast examination. The nurse notes the client's breast appears as shown in the photograph below. Which action by the nurse takes prior-ity?
a. Continue preparations and note the find-ing in the client's chart. b. Ask the client how long this problem has been present. c. Alert the health care provider and prepare to order a mammogram. d. Question the client about routine drug and alcohol intake.
The nurse is preparing to administer intravenous monoclonal antibodies to a patient who has cancer. What is an important nursing action for this patient?
a. Having resuscitation equipment readily available b. Monitoring the patient's renal function during the infusion c. Observing the patient closely for development of a rash d. Performing careful intake and output