A finding that may indicate to a nurse that a client is going into hypovolemic shock is:
A. Skin dryness
B. An increase in pulse rate
C. Flushing and warmth
D. An increase in blood pressure
B
A, B, C, and D. Findings of tachycardia, hypotension, diaphoresis, restlessness, and diminished urinary output indicate impending hypovolemic shock.
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A nurse working with a client who has possible gastritis assesses the client's gastrointestinal system. Which findings indicate a chronic condition as opposed to acute gastritis? (Select all that apply.)
a. Anorexia b. Dyspepsia c. Intolerance of fatty foods d. Pernicious anemia e. Nausea and vomiting
A nurse completing a hospital discharge to home understands that which of the following interventions is most important before discharge
a. Medication reconciliation b. Providing a list of community resources c. Contacting a durable medical equipment facility d. Educating the client on appropriate range-of-motion exercises
The nurse is performing preoperative teaching for a client who is scheduled for surgery in the morning. The client does not presently have any respiratory problems. The nurse's teaching plan includes coughing and deep breathing exercises
Which type of nursing intervention is the nurse performing? 1) Health promotion 2) Treatment 3) Prevention 4) Assessment
The COPD patient has a nursing diagnosis of "Activity intolerance related to inability to meet oxygen needs." The intervention that would be inappropriate for this diagnosis would be:
1. bunch all nursing activities and treatments close together. 2. schedule rest periods during the day. 3. assist patient only when needed, to encourage independence. 4. daily ambulation to build tolerance.