A patient is diagnosed with cardiac tamponade. When planning care, the nurse will include interventions to address which type of shock?
1. Obstructive
2. Hypovolemic
3. Distributive
4. Cardiogenic
1
Rationale 1: Cardiac tamponade can lead to obstructive shock.
Rationale 2: Cardiac tamponade will not lead to hypovolemic shock.
Rationale 3: Cardiac tamponade will not lead to distributive shock.
Rationale 4: Cardiac tamponade will not lead to cardiogenic shock.
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The nurse is planning care for a new patient admitted to the behavioral health unit. Which of the following activities can the nurse expect to occur in the orientation phase of a therapeutic nurse–client relationship?
1. Explore in-depth how the client relates to others. 2. Emphasize growth and positive aspects of the relationship. 3. Discuss with the client how to work together toward a common goal. 4. Identify dysfunctional client thoughts and emotional patterns.
A patient recovering from a broken leg asks why the pain is so sharp. What should the nurse explain about acute pain?
Select all that apply. 1. The pain signal releases catecholamines. 2. The pain signal reduces blood flow to the gut. 3. The pain signal travels along nerve fibers to the spinal cord. 4. The pain signal travels up to the brain portion called the thalamus. 5. The pain signal spreads throughout the cortex, limbic system, and brainstem
Which precaution is most important to teach a patient who is prescribed any type of eye drug administered as eye drops?
a. Apply only the number of drops prescribed. b. Stop the drug immediately if eye redness occurs. c. Wear dark glasses for 1 hour after placing the eye drops. d. Apply pressure to the corner of the eye after the drug has been placed.
While preparing a class on maternal-fetal ABO incompatibility for antepartum patients, the nurse is creating a brochure. Which statement should be included in the brochure information?
1. In most cases, ABO incompatibility is limited to type A mothers with a type B or O fetus. 2. Group A infants, because they have no antigenic sites on the red blood cells (RBCs), are never affected regardless of the mother's blood type. 3. In most cases, ABO incompatibility is limited to type O mothers with a type A or B fetus. 4. ABO incompatibility occurs as a result of the fetal serum antibodies present and interaction between the antigen sites on the maternal RBCs.