A patient on warfarin fell and hit his head on an icy sidewalk and has been diagnosed with a subdural hematoma. Which intervention should be included in the nursing plan of care this patient?
A) Administer aspirin
B) Administer protamine
C) Administer vitamin K
D) Administer thrombolytic therapy
C) Administer vitamin K
Explanation: A) Aspirin and thrombolytic therapy should not be administered because they increase the risk of further subdural bleeding.
B) To reduce the risk of further bleeding following a subdural hematoma, heparin may need to be reversed with protamine, and patients receiving warfarin are given vitamin K to reverse its effects.
C) To reduce the risk of further bleeding following a subdural hematoma, heparin may need to be reversed with protamine, and patients receiving warfarin are given vitamin K to reverse its effects.
D) Aspirin and thrombolytic therapy should not be administered because they increase the risk of further subdural bleeding.
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During examination of the abdomen, the nurse identifies an area of pain to light palpation in the right lower quadrant. What is the most appropriate next action?
A) Deep palpation of the area B) Administer pain medication C) Assess for rebound tenderness D) Auscultate for vascular sounds
What is best for a nurse to offer when encouraging a new patient after a tonsillectomy to increase fluids?
a. Chilled citrus juices b. Tap water sipped through a straw c. Flavored popsicles to suck d. Ice cubes
A nurse performs a health history and physical examination with a patient who has a right leg fracture. Which assessment would be a pertinent negative finding?
a. Patient has several bruised and swollen areas on the right leg. b. Patient states that there have been no other recent health problems. c. Patient refuses to bend the right knee because of the associated pain. d. Patient denies having pain when the area over the fracture is palpated.
The nurse is providing education for a client about the characteristics of Alzheimer's disease. Which information should the nurse include?Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
A. More women than men have Alzheimer's disease. B. The disease is characterized by the degeneration of the neurons. C. Chronic inflammation of the brain may be a cause of the disease. D. The disease mainly affects people over 50 years of age.