The nurse is assessing a patient for Trousseau sign. In which order should the nurse conduct this assessment?
1. Inflate the cuff.
2. Wait 2?5 minutes.
3. Note a point greater than systolic blood pressure.
4. Place a blood pressure cuff above the antecubital space.
5. Observe for carpal spasms in the patient's hands and fingers.
Correct Answer: 4, 1, 3, 2, 5
Trousseau sign is a test for hypocalcemia with resulting tetany (tonic muscle spasms). It is assessed by placing a blood pressure cuff above the antecubital space, inflating the cuff to a point greater than systolic blood pressure and waiting for 2?5 minutes to observe for carpal spasms in the patient's hands and fingers.
You might also like to view...
A female client would like to use biofield therapy for her addiction to nicotine. Which form of therapy would she most likely choose?
a. Aromatherapy b. Acupuncture c. Nicotine patches d. Group therapy
The nurse preparing wellness information for older adult clients is promoting interventions con-sistent with the concepts of the biological theories of aging when suggesting that they: (Select all that apply.)
a. use moisturizers daily to minimize dry skin. b. discuss the use of antacids to control heartburn with their health care provider. c. stay active by interacting with family and friends regularly. d. practice stress reduction techniques on a regular basis. e. consider getting a yearly influenza vac-cination.
The nurse realizes that a patient receiving chemotherapy for cancer is at risk for developing an infection. What actions should the nurse take when caring for this patient?
Select all that apply. 1. Monitoring red blood cell counts monthly. 2. Teaching the patient to avoid small children. 3. Teaching the patient to apply lotion daily to clean skin to prevent drying. 4. Encouraging the patient to consume a diet high in protein and vitamin C. 5. Teaching the patient to report an oral temperature above 98° F.
Nursing interventions such as imagery, relaxation, music therapy, and hypnosis influence the client's:
a. memory about symptoms b. ability to tolerate stressful events c. family relationships d. selection of medical treatments