A client's temperature is 102°F. Which of the following would the nurse also expect to find?
A) Weak, thready pulse
B) Tachycardia greater than 100 bpm
C) Respiratory rate between 12 and 20 breaths/minute
D) Blood pressure 10 mm Hg greater than normal
B
You might also like to view...
Prior to delegating temperature measurement to assistive personnel, the nurse determines the appropriate method of measuring the client's temperature. Safety considerations include: Standard Text: Select all that apply
1. Forcing the thermometer into place to make sure it is accurate. 2. Making sure the client knows not to roll over when a rectal thermometer is in place. 3. Using the blue-tipped thermometer for an oral temperature. 4. Using a site other than oral if the client is known to have frequent seizures. 5. Using probe covers, except for axillary temperatures.
A 2-year old has been resuscitated after ingestion of a cleaning solution. As part of discharge teaching, what is the most important information for the nurse to include?
A) Developmental characteristics of toddlers B) Proper storage and labeling of poisons C) Use of the poison control phone number D) A list of most common household poisons
A patient has been prescribed 1 mg lorazepam (Ativan) sublingual prior to the scheduled insertion of a peripherally inserted central (PIC) line. How should the nurse direct the patient when administering this medication?
A) "Place this under your tongue and let it dissolve there." B) "Try to hold the pill in your mouth as long as possible so that it's effective." C) "Make sure that you don't swallow the pill since that could be dangerous." D) "Chew up this pill but then hold it in your mouth for a minute or two."
Which of the following would the nurse most likely identify as a nursing diagnosis for a client who is receiving an immunization?
A) Risk for Infection B) Acute Pain C) Hyperthermia D) Ineffective Coping