A client is experiencing chest pain that occurs in the third costochondral joint. The onset was sudden; it radiated to the shoulders; and it becomes worse when taking a deep breath or twisting the torso
The nurse suspects that this client is experiencing:
1. aortic dissection.
2. pulmonary embolus.
3. pneumothorax.
4. musculoskeletal-costochondritis.
4
The pain of costochondritis includes locations at the 3rd, 4th, or 5th costochondral joint; a sudden or gradual onset; and radiation to the shoulders. Costochondritis is aggravated by deep inspirations or twisting. The pain of aortic dissection is sudden and tearing, and it radiates to the shoulders, neck, back, and abdomen. The pain of a pulmonary embolus includes a sudden, sharp pleuritic pain that varies with respiration. The pain of a pneumothorax is a sudden onset of tearing or pleuritic pain that is worsened by breathing.
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1. "What can we do to accommodate your needs during your stay here?" 2. "I will let your healthcare provider know that you need to be discharged." 3. "Fasting is harmful to your body." 4. "You must have food during times of illness."
The nurse is planning to provide care according to Leininger's theory of culturally congruent care. What should the nurse include when providing care to the client?
1. Care should be influenced by the organizational structure. 2. The client's familiar lifeways are preserved. 3. Accommodations should be satisfying to clients. 4. Nursing care must be repatterned to help the client move toward wellness. 5. Care should be structured to fit the nurse's needs
For select clients, physical restraint is considered to be a beneficial intervention. This is based on which premise?
A. Clients with poor boundaries do not respond to verbal redirection, and they need firm and consistent limit setting.B. Clients with limited internal control over their behavior need external controls to prevent harm to themselves and others.C. Clients with antisocial tendencies need to submit to authority.D. Clients with behavioral dysfunction need behavioral interventions.
The nurse is planning care for a patient with severe symptoms of tinnitus, vertigo, sensorineural hearing deficit, nausea, and vomiting. What issue should the nurse identify as a priority for this patient?
A. Ensuring adequate nutritional intake B. Difficulty sleeping C. Anticipating future attacks D. Problems with interpersonal relationships