The nurse is caring for a group of clients with respiratory disorders and should know that which client should not be placed on continuous positive airway pressure (CPAP) to assist with respiratory distress?
A. The client with chronic obstructive pulmonary disease (COPD) who is complaining of shortness of breath
B. The client whose respirations have fallen to 8/minute after receiving morphine sulfate
C. The client who experiences apnea during sleep
D. The client who is experiencing wheezing and is having difficulty moving air adequately
Answer: B
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The nurse is caring for a client with systemic inflammatory response syndrome (SIRS). Which assessment finding would the nurse anticipate? Select all that apply.
A) A white blood cell (WBC) count less than 3,000 cells/mm3 or greater than 10,000 cells/mm3 B) A heart rate of greater than 90 beats per minute C) A respiratory rate of greater than 16 respirations per minute D) A body temperature of less than 36°C or greater than 38°C E) The presence of greater than 20% immature neutrophils
The charge nurse is observing a new staff nurse who is assessing a patient with a traumatic spinal cord injury for sensation. Which action indicates a need for further teaching of the new nurse about neurologic assessment?
a. The new nurse tests for light touch before testing for pain. b. The new nurse has the patient close the eyes during testing. c. The new nurse asks the patient if the instrument feels sharp. d. The new nurse uses an irregular pattern to test for intact touch.
A type 2 diabetic patient has been well controlled on a sulfonylurea but has recently been experiencing repeated hypoglycemic reactions. The nurse should assess the patient for:
1. infection. 2. the concomitant use of nonsteroidal antiinflammatory agents. 3. increased emotional stress. 4. a reduced physical activity level.
The perinatal nurse provides information about postpartum depression to all families members because of the potential danger not only to the mother but also to the __________
Fill in the blank with the appropriate word.