A nurse is providing care to a client with pericarditis and notes increasing difficulty in auscultating the client's heart sounds. What is the nurse's best first action?
A. Use a Doppler to assess heart sounds.
B. Increase the intravenous flow rate.
C. Administer oxygen by mask.
D. Notify the physician.
D
Heart sounds that become muffled or more difficult to auscultate in a client with pericarditis may indicate the presence of tamponade, a medical emergency.
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A nurse assesses clients on the medical-surgical unit. Which client should the nurse identify as at high risk for pancreatic cancer?
a. A 26-year-old with a body mass index of 21 b. A 33-year-old who frequently eats sushi c. A 48-year-old who often drinks wine d. A 66-year-old who smokes cigarettes
Which is an early indication of anticoagulant overdose?
a. Abdominal pain b. Bleeding gums c. Low blood pressure d. Pallor
The name for the boundaries or focus of a discipline is
A. Imagination. B. Domain. C. Tradition. D. Value.
During which step of the nursing process does the nurse collect information?
A) Diagnosis B) Planning C) Analysis D) Evaluation