A client with PIH experiences a total abruption and has an emergency cesarean section. Her infant is stillborn. In the recovery room, her dressing becomes saturated with blood. The nurse should
a. check the blood pressure c. mark and reinforce the dressing
b. increase the IV fluids d. notify the physician
D
The nurse's priority action would be to notify the physician. Vital sign monitoring is very important, but the blood pressure does not show a decrease until approximately 40 percent blood loss has occurred. Increasing the IV fluids is not an appropriate nursing intervention without an order from the primary care provider. Marking and reinforcing the dressing is important, but it is not the most important.
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A nurse is notified when a patient, newly admitted with liver and gallbladder disease, complains of pain in the right middle back and asks for some pain medication. What is the best interpreta-tion of this reported assessment by the nurse?
a. The patient is just complaining to see whether the staff will give out pain medi-cations. b. The patient has referred pain sensations. The nurse should follow orders for admi-nistering pain medication. c. The patient has an injury on the back from an unknown cause that needs immediate assessment. d. The patient is a chronic complainer with anxieties about his condition.
The individual(s) who are widely known for the development of hospice care in the United States is/are (Select all that apply)
a. Dame Cicely Saunders. b. Elisabeth Kübler-Ross. c. Florence Nightingale. d. Florence Wald.
Which of the following statements are true regarding rotational therapy? (Select all that apply.)
a. Continuous lateral rotation therapy (CLRT) can be effective for improving oxygenation if used for at least 18 hours/day. b. Kinetic therapy can decrease the incidence of ventilator-acquired pneumonia in neurologic and postoperative patients. c. Use of rotational therapy eliminates the need for other pressure ulcer prevention strategies. d. CLRT helps avoid hemodynamic instability secondary to the continuous, gentle turning of the patient. e. CLRT has minimal pulmonary benefits for critically ill patients.
A patient has an advance directive that indicates no CPR should be performed under any circumstance. When the nurse enters the patient's room and finds that he has coded, the nurse immediately begins CPR
The nurse is at risk for which of the following? a. Negligence c. Assault b. Battery d. Licensure