A client has been admitted with a gastrointestinal ulcer. The client is NPO and has a nasogastric tube in place connected to low suction. What form of shock should the nurse monitor this client for?
A. Distributive shock
B. Obstructive shock
C. Cardiogenic shock
D. Hypovolemic shock
D
This client is at risk for hypovolemic shock caused by bleeding from gastrointestinal ulcers, leading to fluid volume loss, and from nasogastric suction that can compound the situation if the client is not sufficiently hydrated with IV fluids.
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Which nutritional group should the nurse teach the diabetic client with normal renal function to rigidly control to reduce the complications of diabetes?
A. Fats B. Fiber C. Proteins D. Carbohydrates
A 15-year-old patient is seen for evaluation by court order
The parents seek to have this teen declared incorrigible because of excessive drinking, habitually running away, and prostitution. The nurse interviewing the patient should recognize that these behaviors often occur in adolescents who: a. are victims of childhood sexual abuse. b. have antisocial personality disorder. c. are experiencing schizophrenia. d. have been ritually abused.
Nausea, vomiting, and an irregular heart rate develop in a patient who takes oral digoxin every morning. What is the nurse's best action?
a. Give prescribed diphenhydramine (Phenergan) as needed. b. Check the patient's cardiac monitor strip. c. Assess the apical pulse for a full minute. d. Check laboratory results for a digoxin level.
C.W.'s condition deteriorates; on the third day after admission she experiences intractable abdominal painand unrelenting nausea and vomiting
C.W. is taken to the operating room because of probable sBO and is readmitted to your unit from the postanesthesia care unit. during surgery, 38 inches of her small bowel were found to be severely stenosed with two areas of visible perforation. Much of the remaining bowel is severely inflamed and friable. A total of 5 feet of distal ileum and 2 feet of colon have been removed, and a temporary ileostomy was established. she has a Jackson-Pratt (JP) drain to bulb suction in her right lower quadrant (RLQ), and her wound was packed and left open. she has two peripheral IVs, a salem sump nasogastric tube (NGT), and a Foley catheter. Her vital signs (Vs) are 112/72, 86, 24, 100.8° F (38.2° C) (tympanic). You attach her NGT to low-continuous wall suction per the postoperative orders. You begin a thorough postoperative assessment of C.W.'s abdomen. What does your assessment include? List the steps in the order in which the assessment should be completed.