The nurse caring for a 90-year-old patient with a closed head injury would immediately report:
1. blood pressure change from 147/72 to 176/70.
2. respiration rate increase from 14 to 18.
3. slow pupillary reaction bilaterally.
4. temperature decrease from 100.2 to 97.6.
1
The widening pulse pressure is an indicator of increased ICP. Respirations and temperature are returning to more normal levels. Older adults have a slowed pupillary response as they age.
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The nurse should monitor the client taking antipsychotic medications for which adverse reactions? (Select all that apply.)
a. arrhythmias d. neuroleptic malignant syndrome b. extrapyramidal side effect e. tardive dyskinesia c. fatal hypertensive crisis
A pregnant client tells her nurse that she is interested in arranging a home birth. After educating the client on the advantages and disadvantages, which statement would indicate that the client understood the information?
A) "I like having the privacy, but it might be too expensive for me to set up in my home.". B) "I want to have more control, but I am concerned if an emergency would arise.". C) "It is the safest method for giving birth because there are no interferences.". D) "The midwife is trained to resolve any emergency, and she can bring any pain meds.".
T cells produce
1. cytokines. 2. leukotrienes. 3. lymphocytes. 4. erythrocytes.
A client with a dog bite is admitted to a local healthcare facility for treatment. What immediate intervention should the nurse perform to treat the client's dog bite?
A) Cleanse the wound with warm, soapy water. B) Apply direct, firm pressure at the site. C) Apply an ice pack or ice bag. D) Apply an Ace roller bandage.