The nurse is caring for a postoperative client who suddenly reports difficulty breathing and sharp chest pain. After notifying the Rapid Response Team, what is the nurse's priority action?
a. Elevate the head of the bed and apply oxygen.
b. Listen to the client's lung sounds.
c. Pull the call bell out of the wall socket.
d. Assess the client's pulse oximetry.
A
The client's immediate need is to have oxygen applied. The nurse should then assess the client's pulse oximetry.
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A normal maintenance dose for digoxin is 0.125 to 0.5 mg/day. In which of the following patients would the nurse most likely administer a lower-than-normal maintenance dose of digoxin?
A) A 25-year-old male with congestive heart failure and atrial fibrillation B) A 32-year-old female with cardiomegaly C) A 79-year-old male with cardiomegaly D) A 42-year-old female with a third heart sound
After months of infertility procedures, a physician informs a 32-year-old patient that she will never conceive. As the nurse enters the examination room, the patient states, "I guess I'm a fail-ure as a woman
" Based on this statement, what is the most appropriate nursing diagnosis? a. Sexual dysfunction b. Ineffective health maintenance c. Disturbed body image d. Ineffective coping
The interdisciplinary team is looking at the results of a client's MRI. The results show increased activity in the amygdala. When the nurse makes an assessment of the client, which nursing diagnosis might be expected?
A) Risk for harm (others) as evidenced by persecutory delusions B) Self-care deficit as evidenced by autistic thinking C) Alterations in thought as evidenced by hallucinations (visual) D) Sensory perception, disturbed related to maladaptive cognitive responses
Because the child in isolation is not permitted to go to the playroom, the nurse explains that toys that are:
a. Brought from the playroom will have to be thrown away b. Washable can be brought from the playroom and later disinfected c. From the playroom must be sealed in a plastic bag d. For the child's use must be brought from home