The nurse is monitoring a patient who has been treated for several days for septic shock after surgery. Which of the following findings indicate that the patient is improving? (Select all that apply.)
a. Urine output less than 25 mL/hr
b. SpO2 94%
c. Blood pressure 110/90 mm Hg
d. Pulse 75 beats/minute
e. Temperature 101°F (38.3°C)
f. pH is 7.33
ANS: B, C, D
B, C, and D indicate vital signs within normal limits that show improvement. A. Urine output should be 30 mL/hr to be normal. E. Normal temperature is 98.6°F (37°C). F. pH below 7.35 is abnormal and indicative of ongoing acidosis related to shock.
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A nurse is preparing a patient who will stop taking lorazepam [Ativan] for anxiety and begin taking buspirone [Buspar]. Which statement by the patient indicates a need for further teaching?
a. "I can drink alcohol when taking Buspar, but not grapefruit juice." b. "I may need to use a sedative medication if I experience insomnia." c. "I may not feel the effects of Buspar for a few weeks." d. "I should stop taking the Ativan when I start taking the Buspar."
A nurse is assessing a patient who has heart failure. The patient complains of shortness of breath, and the nurse auscultates crackles in both lungs. The nurse understands that these symptoms are the result of:
a. decreased force of ventricular contraction. b. increased force of ventricular contraction. c. decreased ventricular filling. d. increased ventricular filling.
Suicidal ideation is defined as:
a. thoughts about wanting to die b. thoughts with at least one attempt c. attempts that are unsuccessful d. attempts using nonlethal methods
The nurse using Erikson's theory to assess a 20-year-old client's developmental status expects to find which of the following behaviors?
1. Coping with physical and social losses 2. Enjoys participating in the community 3. Applying self to learning skills 4. Overcoming a sense of guilt or frustration