The nurse is caring for a patient who was in a house fire. The patient currently has a hoarse voice and has soot in the sputum
Over the next 24 hours, what will the patient experience as manifestations of a lower airway injury? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Increased mucous production
2. Bronchospasm
3. Alteration in breath sounds
4. Chest pain
5. Peripheral neuropathy
1,2,3
Rationale 1: Chemical irritation of the alveolar tissue causes increased mucous production.
Rationale 2: Chemical irritation of the alveolar tissue causes bronchospasm.
Rationale 3: After 24 hours the patient's chest x-ray may show the development of patchy atelectasis.
Rationale 4: Chest pain is not a manifestation of a lower airway injury.
Rationale 5: Peripheral neuropathy is not a manifestation of a lower airway injury.
You might also like to view...
For iron deficiency anemia, the initial management would include correcting the underlying bleeding and
A) administering iron supplements orally. B) transfusing with packed cells. C) instructing the patient to eat organ meats. D) promoting collateral circulation by exercising.
The nurse is studying client assessment data in efforts to formulate applicable nursing diagnoses. Which nurse theorist was instrumental in defining client problems that served as a foundation for the development of nursing diagnoses?
a. Joyce Travelbee c. Virginia Henderson b. Faye Abdellah d. Josephine Paterson
A patient referred to the eating disorders clinic has lost 35 pounds during the past 3 months. To assess eating patterns, the nurse should ask the patient:
a. "Do you often feel fat?" b. "Who plans the family meals?" c. "What do you eat in a typical day?" d. "What do you think about your present weight?"
Parents tell the nurse that their 1-year-old son often sleeps with them. They seem unconcerned about this. The nurse's response should be based on which statement?
a. Children should not sleep with their parents. b. Separation from parents should be completed by this age. c. Daytime attention should be increased. d. This is a common and accepted practice, especially in some cultural groups.