Describe six interventions you will perform over the next few hours for K.B. based on this
priority.
What will be an ideal response?
• Monitor BP, temperature, and neurologic status.
• Maintain ECG and oxygen saturation monitoring.
• Auscultate lung sounds frequently.
• Titrate oxygen per protocol.
• Administer IV fluids and medications as prescribed.
• Because of increased cardiac workload, assess for chest pain, development of an S3 sound, and
presence of jugular venous distention (JVD) and edema, and monitor urine output in addition
to VS.
• Promote reduction in body temperature by administering the as-needed acetaminophen and
maintaining a cool environmental temperature.
• Maintain I&O. Monitor laboratory values as available.
• Maintain a safe, calm environment; implement seizure precautions.
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What laboratory value change should indicate to a nurse that a patient with renal failure has entered the oliguric stage?
a. Blood urea nitrogen (BUN) level rises. b. Serum calcium increases. c. Blood volume decreases. d. Urine osmolality increases.
Which statement by a woman diagnosed with premenstrual syndrome indicates that further health teaching is needed?
a. "I will not eat chips or pickles." b. "Coffee and chocolate can make me more irritable and nervous." c. "Drinking alcohol makes me more depressed." d. "I'll eat only three meals per day."
Slight bluish discoloration of hands and feet
What will be an ideal response?
Because of cultural characteristics, in which of the following cultural groups would a nurse's assessment of mood and affect be most challenging? Select all that apply
A. Arab Americans B. Native Americans C. Latino Americans D. Western European Americans E. Asian Americans