The obese postsurgical patient complains of sudden discomfort in her leg. The nurse assesses the leg and finds it cold and pale, with no pedal or popliteal pulse. These are signs of:
1. venous thrombosis.
2. arterial occlusion.
3. vascular spasm.
4. paresthesia.
2
Signs of an acute arterial occlusion can include severe pain, absent pulses, or very pale or mottled skin.
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The nurse is caring for a patient 5 days following clipping of an anterior communicating artery aneurysm for a subarachnoid hemorrhage
The nurse assesses the patient to be more lethargic than the previous hour with a blood pressure 95/50 mm Hg, heart rate 110 beats/min, respiratory rate 20 breaths/min, oxygen saturation (SpO2) 95% on 3 L/min oxygen via nasal cannula, and a temperature of 101.5° F. Which physician order should the nurse institute first? a. Blood cultures (2 specimens) for temperature > 101° F b. Acetaminophen (Tylenol) 650 mg per rectum c. 500 mL albumin infusion intravenously d. Decadron 20 mg intravenous push every 4 hours
A patient with malaise has been taking daptomycin (Cubicin) for an infection and is concurrently taking simvastatin (Zocor). The nurse should be concerned if the patient complains of
a. nausea. b. tiredness. c. muscle pain. d. headache.
A client is about to be discharged from a psychiatric–mental health facility. When should the discharge planning process begin?
A) On admission B) One to 2 days before discharge C) Once the discharge order is written D) When the client is preparing to leave the facility
The nurse manager knows there is conflict between two of the charge nurses. This nurse manager makes the decision to postpone an intervention and allow the conflict to escalate
Which best describes the goal of the nurse manager in making this decision? 1. Allow sufficient time for the conflict to spontaneously resolve. 2. Gain time to identify all possible conflict-solving strategies. 3. Prevent the nurse manager from making a premature decision. 4. Motivate the participants to work through their own conflict.