The nurse suspects a client is experiencing left-sided heart failure when which of the following is assessed? (Select all that apply.)
1. Decreased basilar lung sounds
2. Distended neck veins
3. Extra heart sounds
4. Lung crackles
5. Tachycardia
6. Weight gain
1, 3, 4, 5
Signs of left-sided heart failure are dysrhythmic heart rate, tachycardia, heart murmurs, extra heart sounds, lung crackles, and decreased basilar lung sounds. Distended neck veins and weight gain are symptoms of right-sided heart failure.
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A hospital patient who is being treated for a urinary tract infection has developed a fever. The nurse has responded by administering a dose of acetaminophen. In what way does acetaminophen contribute to a reduction in fever?
A) Acetaminophen inhibits the thermoregulatory function of the hypothalamus. B) Acetaminophen increases the production and release of interferons. C) Acetaminophen inhibits prostaglandin synthesis. D) Acetaminophen causes the lysis of fever-producing cells.
The nurse inspecting the skin of a dark-skinned child notices an area that is a dusky red or violet color. This skin coloration is associated with what?
a. Cyanosis b. Erythema c. Vitiligo d. Nevi
Eardrops are prescribed for a patient. Which of the following assessment findings would cause the nurse to question this order?
a. patient is hard of hearing b. patient has a perforated tympanic membrane c. patient has wax in the ears d. patient has an earache
A nurse is caring for a client with streptococcal pharyngitis. The nurse has to initiate precautions for the client. Based on this information, what type of precautions should the nurse initiate and review the procedures with staff members?
A) Droplet Precautions B) Contact Precautions C) Airborne Precautions D) Protective Precautions