The nurse is checking a patient's blood pressure before administering an antihypertensive, and gets a reading of 88/52 mm Hg. What is the nurse's best action?
a. Give the patient a cup of coffee and retake the blood pressure in 30 minutes.
b. Document the finding as the only action and administer the drug as usual.
c. Raise the side rails and apply oxygen by mask or nasal cannula.
d. Hold the dose and notify the prescriber.
D
This patient's blood pressure is quite low. If the patient is receiving this drug because he or she has hypertension, another dose of the drug right now could make the patient's blood pressure dangerously low. Sometimes a patient may be prescribed an antihypertensive drug for another reason. The nurse must check with the prescriber before administering this antihypertensive drug dose.
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During an assessment, a pregnant patient tells the nurse that "white foods" are not consumed in the patient's culture. What should the nurse do first after learning this information?
A) Ask the patient to define "white foods.". B) Document that "white foods" are not eaten. C) Explain that "white foods" have nutrients needed for pregnancy. D) Discuss reasons why "white foods" are avoided in the patient's culture.
The home care nurse is planning to visit a "PT" with Meniere's disease. The nurse reviews the physician prescriptions and expects to note that which of the following dietary measures is prescribed?
A) A low-fiber diet with decreased fluids B) A low-sodium diet and fluid restriction C) A low-fat diet with restriction of citrus fruit D) A low-Carbohydrate diet and the elimination of red meats
While caring for the client with a recurrent fever, the nurse plans for:
1. Morning care to provide for personal hygiene. 2. Afternoon care. 3. HS care. 4. PRN care.
While assessing her patient, what does the nurse interpret as a positive sign of pregnancy?
a. Fetal movement felt by the woman b. Amenorrhea c. Breast changes d. Visualization of fetus by ultrasound