The patient in the ICU is being treated for left lower lobe pneumonia. What assessment findings by the nurse may indicate that the patient is developing systemic inflammatory response syndrome (SIRS)? Select all that apply
A) White blood cell count of 24,000/mm3
B) Respiratory rate of 24
C) Blood pressure of 100/60
D) Heart rate 96
E) Atrial fibrillation
A, B, D
You might also like to view...
Information that the LPN/LVN may collect during a complete health history includes Standard Text: Select all that apply
1. Vital signs 2. Dietary habits 3. Impairments 4. Medication history 5. Height
Postmenopausal women are at risk for skeletal changes. When developing a plan of care for postmenopausal women, a nurse should remember which of the following?
a. Exercise provides little benefit for the middle-age adult. b. Middle-age women should avoid dietary calcium to prevent osteoporosis. c. Exercise and fitness clubs have limited activities. d. Physical activities help improve balance and coordination.
A patient with giardiasis is being treated with metronidazole. What comment by the patient would indicate that the nurse needs to provide further teaching?
A) "I can continue to work delivering pizza because the disease is not contagious." B) "I will not lose my hair during drug therapy." C) "I know I will experience diarrhea during this time." D) "I shouldn't experience irregular menstrual periods."
Which potential hazard is most important for a patient with an automatic implantable cardiover-ter-defibrillator (AICD) to avoid?
a. Static electricity from synthetic fabric b. Airport security detection devices c. Constricting clothing and belts d. High altitudes