The nurse is caring for a client who has undergone a portal-systemic shunting procedure and, on assessment of the client's abdomen, the nurse notes an increase of abdominal girth. What is the nurse's priority action?
A. Document the finding as the only action.
B. Notify the physician.
C. Irrigate the shunt.
D. Clamp the shunt.
B
The client with increasing abdominal girth after a shunting procedure may be experiencing shunt failure or excessive sodium administration. The physician should be notified to assess the shunt or re-institute diuretic therapy.
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The nurse is caring for a patient following surgery for a brain tumor. Three days after surgery, the LVN enters the room and finds the patient jerking rhythmically in the bed. The patient does not respond to the LVN's questions
What should the nurse do first? a. Go find the RN to assist. b. Hold the patient firmly to keep the patient from injuring someone. c. Call the physician. d. Protect the patient from injury and observe the sequence of events.
A 72-year-old female is recovering from abdominal surgery on the medical-surgical unit. The surgery was very stressful and prolonged; the nurse notes on the chart that her blood sugars are elevated yet she has not been diagnosed with diabetes
The nurse realizes: A) It is a result of antidiuretic hormone. B) She must have had diabetes prior to surgery. C) She has become a diabetic from the abdominal surgery. D) The blood sugars are probably a result of the "fight or flight" reaction.
Damage to the upper portion of the reticular activating system results in which condition?
a. Seizures c. Apnea b. Diabetes insipidus d. Impaired consciousness
According to consumer opinion polls, _____ consistently show up as rated "Number One" trusted professionals
a. firemen c. physicians b. policemen d. nurses