When assessing the client who is receiving intra-arterial infusion, the nurse is unable to palpate the pulse distal to the insertion site. What is the nurse's best action?
A. Manipulate the catheter to move it away from the blood vessel wall.
B. Discontinue the medication and flush the line with heparin.
C. Document the findings as the only action.
D. Notify the emergency team.
D
The loss of a pulse distal to an intra-arterial infusion site indicates arterial occlusion. The risk of inadequate tissue perfusion or the release of an embolism is high and considered an emergency.
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Level 8 on the Stimulus-Reaction Level Scale indicates a patient that is
A) alert. B) very drowsy. C) unconscious but withdraws from pain. D) unconscious with no response to pain.
Which quality does the nurse need to provide caring?
a. Sensitivity to the needs of other nurses b. Longing to help others live a healthy life c. Desire to have a stable career and income d. Ability to create a trusting environment
The nurse working night shift recognizes the value of allowing clients to sleep uninterrupted whenever possible. Which client would the nurse wake to assess vital signs?
1. Postoperative client who had surgery 5 days ago and will be discharged in the morning 2. Client who has been afebrile for 3 days on antibiotics 3. Client who required medication earlier in the day for chest pain 4. A client who required the insertion of an indwelling catheter this evening secondary to urine retention related to an enlarged prostate
Which theorist believes that health is associated with the degree of congruence between the self as perceived and the self as experienced?
a. Jean Watson b. Martha Rogers c. Florence Nightingale d. Rosemarie Parse