To best assess the child with severe burns for adequate perfusion, the nurse monitors:
a. Distal pulses. c. Urine output.
b. Skin turgor. d. Mucous membranes.
ANS: C
Urine output reflects the adequacy of end-organ perfusion. Distal pulses may be affected by many variables. Urine output is the most reliable indicator of end-organ perfusion. Skin turgor is often difficult to assess on burn patients because the skin is not intact. Mucous membranes do not reflect end-organ perfusion.
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The primary focus of your interventions for a 6-year-old child who sleepwalks would be to:
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The nurse receives report on the assigned client and learns the client has sundowner's syndrome. Which of the following findings would be consistent with this syndrome?
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Cocaine exerts which of the following effects on a client?
A. Stimulation after 15 to 20 minutes B. Stimulation and anesthetic effects C. Immediate imbalance of emotions D. Paranoia
The nurse is reinforcing discharge teaching provided to a patient taking antirejection medication following a heart transplant. Which beverage should the nurse instruct the patient to avoid?
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