Which of T.C.'s vital sign values would be most important for the UAP to report to you
immediately?
a. Heart rate of 100 beats/min
b. Temperature of 100 ° F (37.8 ° C)
c. Respiratory rate of 9 breaths/min
d. Blood pressure of 160/80 mm Hg
c
At this time, a respiratory rate of 9 would indicate that T.C. is hypoventilating. You would need to
assess T.C. immediately, and if she was not arousable to a higher level and her pulse oximetry was
lowered, the physician would need to be notified because T.C. might require medical reversal of her
analgesic and/or anesthetic, possibly with naloxone (Narcan). It is most likely that the elevated heart
rate is a compensatory mechanism for hypoxemia and that the elevated temperature, because it is
too early for an infection, is related to early atelectasis.
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After 30 minutes, the patient's blood pressure is 120/65, and the pulse is 100. The patient's skin is cold, moist, and pale. The patient is showing symptoms of which of the following? A) Hypothermia B) Hypovolemic shock C) Neurogenic shock D) Malignant hypothermia
Which signs/symptoms would be considered classical signs of meningeal irritation?
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A 77-year-old client being treated for glaucoma asks the nurse what causes glaucoma. The nurse bases the response on the knowledge that the increase in intraocular pressure is a result of:
a. a breakdown in the absorption process b. spasms of the orbicular muscle. c. changes to the suspensory ligaments, ciliary muscles, and parasympathetic nerves. d. bits of broken coalesced vitreous from the peripheral or central part of the retina.
A nurse practitioner is treating a client for uncomplicated adult primary insomnia on an outpatient basis
After ruling out correctable medical causes for the insomnia, the nurse practitioner formulates a plan of care to provide primary care cognitive therapy to treat the insomnia. Whether or not this plan of care is appropriate depends on the knowledge that cognitive therapy developed for use by a primary care provider: a. is not effective because cognitive therapy can be performed only by a cognitive behavioral therapy specialist b. appears to have a good short-term efficacy for managing uncomplicated adult primary insomnia c. contradicts the results of multiple studies that show no significant benefit from cognitive behavioral therapy for the treatment of insomnia d. results in the same efficacy and side-effect profile as placebo therapy