When caring for a patient who has an arterial catheter in the left radial artery for arterial pressure–based cardiac output (APCO) monitoring, which information obtained by the nurse is most important to report to the health care provider?
a. The patient has a positive Allen test.
b. There is redness at the catheter insertion site.
c. The mean arterial pressure (MAP) is 86 mm Hg.
d. The dicrotic notch is visible in the arterial waveform.
ANS: B
Redness at the catheter insertion site indicates possible infection. The Allen test is performed before arterial line insertion, and a positive test indicates normal ulnar artery perfusion. A MAP of 86 is normal and the dicrotic notch is normally present on the arterial waveform.
You might also like to view...
A 2-year-old is seen for a well-child visit and is scheduled to receive immunizations. The child weighed 22 lb (9.97 kg) at 1 year of age (1 year ago). Today the child weighs 23 lb (10.4 kg)
Which conclusion is most appropriate for the nurse to make regarding this assessment data? A. The child is at an expected weight. B. The child is over expected weight. C. The child is seriously overweight. D. The child is underweight for age.
The nurse is caring for a patient who just had surgery. What is the nurse's highest priority?
A) Assessing for hemorrhage B) Maintaining a patent airway C) Managing the patient's pain D) Assessing vital signs every 15 minutes
A clinic nurse developed objectives for a diabetic education program. The characteristics of well-written objectives include that they should be what? (Select all that apply.)
a. Achievable b. Understandable and specific c. People-oriented d. Manager-oriented e. Means-oriented f. Measurable
After a mastectomy a woman should be instructed to perform all of the following except:
a. Emptying surgical drains twice a day and as needed. b. Avoiding lifting more than 4.5 kg (10 lb) or reaching above her head until given permission by her surgeon. c. Wearing clothing with snug sleeves to support the tissue of the arm on the operative side. d. Reporting immediately if inflammation develops at the incision site or in the affected arm.