A nurse sees smoke emerging from the suction equipment being used. Which is the greatest priority in the event of a fire?
a. Report the fire.
b. Extinguish the fire.
c. Protect the clients.
d. Contain the fire.
Answer: c. Protect the clients.
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The nurse administers ambrisentan (Letairis) to the patient diagnosed with pulmonary arterial hypertension. What single indicator would the nurse use to evaluate the effectiveness of this medication?
A) Oxygen saturation B) Resting respiratory rate C) Exercise tolerance D) Breath sounds
The home health nurse assesses signs of hypoglycemia in an older patient. Which factors could cause this phenomenon? Select all that apply.
1. An illness 2. Poor sleep routine 3. Missing a meal 4. Unplanned exercise 5. Too much medication
The nurse is helping a student prepare to insert a nasogastric tube for an adult client with a bowel obstruction. Which actions by the student indicate to the nurse that a review of the procedure is needed? (Select all that apply.)
a. Gathering supplies, including an 8 Fr Le-vin tube, sterile gloves, tape, and wa-ter-soluble lubricant b. Performing hand hygiene and positioning the client in high Fowler's position, with pillows behind the head and shoulders c. Attaching a 60-mL irrigation syringe to the end of the nasogastric tube before in-serting it into the nose d. Instructing the client to extend the neck against the pillow once the nasogastric tube has reached the oropharynx e. Checking for correct placement by checking the pH of the fluid aspirated from the tube f. Securing the nasogastric tube by taping it to the client's nose and pinning the end to the pillowcase g. Connecting the nasogastric tube to inter-mittent medium suction with an an-ti-reflux valve on the air vent
During the physical examination of a client, the nurse checks the client for neck vein distention. To perform this assessment properly, the client should be positioned
a. first lying, then sitting, then standing. b. in a side-lying position with knees flexed. c. lying supine with head of bed elevated 15-30 degrees. d. sitting upright with neck flexed slightly forward.