The healthcare team has planned to begin weaning a patient from the mechanical ventilator in the morning. The nurse should alert the team to which situations that could decrease the chance of successful weaning?
1. The patient has developed a fever.
2. The patient was suctioned twice during the night for a small amount of thin secretions.
3. ABGs reveal a pH of 7.34.
4. Positive end expiratory pressure (PEEP) is maintained at 8 cm H20.
5. The patient's serum sodium level is 138 mEq/L.
1, 4
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A teenage patient comes to the emergency department with complaints of an inability to breathe and a sharp pain in the left side of his chest. The assessment findings include cyanosis, tachypnea, tracheal deviation to the right, decreased tactile
fremitus on the left, hyperresonance on the left, and decreased breath sounds on the left. The nurse interprets that these assessment findings are consistent with: a. Bronchitis. b. Pneumothorax. c. Acute pneumonia. d. Asthmatic attack.
Your patient has been taking a SSRI antidepressant for 6 weeks. On arrival at the clinic, which observation would indicate a positive outcome from the medication?
A. Patient reports sleeping 12 hours a night. B. Patient reports sleeping 3 hours a night. C. Patient reports a weight loss of 10 pounds. D. Patient arrives neatly dressed.
A young mother was very proud because she had been taking her 9-month-old with her to various garage sales where she had purchased a lot of toys for very little money. Which of the following would be the most appropriate response by the nurse?
a. "Be sure there are no small pieces as young children can easily choke." b. "Fantastic. Saving money on toys will allow you to buy more fresh fruits and vegetables." c. "Toddlers love new toys; they will help with cognitive development." d. "You are doing an excellent job of giving your child lots of stimulation with new playthings."
The nurse clarifies that the lymphocytes that actually produce either sensitized lymphocytes or antibodies are the:
a. B lymphocytes. b. T cells. c. suppressor T cells. d. stem cells.