What is the priority nursing intervention when caring for a client with severe acute respiratory syndrome (SARS)?
a. Maintaining Standard Precautions
b. Administering antibiotics
c. Assessing oxygenation
d. Making sure the client stays hydrated
C
The client with SARS can rapidly develop hypoxia. Assessing oxygenation is a priority because intubation and mechanical ventilation may be needed. Maintaining precautions is essential for preventing the spread of this illness, but oxygenation and client safety are the highest priorities. Antibiotics are administered if bacterial pneumonia occurs with this disease. Hydration is impor-tant to make sure secretions stay liquefied; this is also secondary to oxygenation.
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The nurse is assessing an individual's spirituality. Which components would the nurse identify as relating to the patient's overall health? Select all that apply
1. The need to answer questions about life 2. The need to worship the transcendent 3. The desire to attend religious ceremonies 4. The desire to live in harmony with the transcendent 5. The need to recognize something that is bigger than ourselves
A patient who has just returned to the United States from a trip to a region in which malaria is endemic is admitted to the hospital
The patient is diagnosed with malaria, high doses of mefloquine (Lariam) are prescribed for chloroquine-resistant Plasmodium falciparum. After 3 days, the nurse assigned to the patient is preparing to administer a dose of the medication when the patient begins to complain of dizziness (vertigo) and confusion and displays symptoms of psychosis. The nurse recognizes these symptoms as ______________ and should _________. a. findings consistent with malaria; administer the medication b. toxicity; hold the medication and have a blood sample drawn for measurement of the drug level c. an adverse effect; discontinue the medication d. a side effect of the medication; monitor the patient closely
When helping a victim of abuse, the nurse should make which of the following the first priority?
a. Acknowledging that the violence occurred b. Respecting and caring for the victim c. Making sure the victim is safe d. Caring for any injuries
You have inserted an IV catheter into a vein in a patient's hand and have secured the IV line appropriately. You assess the flow of the IV and note that it is not flowing. You should FIRST:
A. gently manipulate the catheter until the IV starts flowing. B. ensure that the constricting band has been released. C. immediately stop the infusion and apply pressure. D. lower the IV bag to see if blood flows up the IV tubing.