The nurse is caring for a postoperative patient with chronic obstructive pulmonary disease (COPD). Which assessment would be a cue to the patient developing postoperative pneumonia?
a. Bradycardia
b. Change in sputum characteristics
c. Hypoventilation and respiratory acidosis
d. Pursed-lip breathing
B
Change in the character of sputum may signal the development of a respiratory infection in the patient with COPD. Additional symptoms include anxiety, wheezing, chest tightness, tachypnea, tachycardia, fatigue, malaise, confusion, fever, and sleeping difficulties.
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While conducting an assessment interview regarding stress and coping patterns, the nurse identifies the following questions that will encourage the client to communicate information: Standard Text: Select all that apply
1. How do you usually handle stressful situations? 2. How would you describe yourself as a person? 3. Do you like your work? 4. What are your strengths in relationships? 5. Are you having any stress at work?
A client with a fever is ordered to receive sulfonamide therapy for an infection. The nurse needs to evaluate the client for which of the following during the course of therapy? Select all that apply
A) Response to drug therapy B) Elevated blood glucose levels C) Mental status changes D) Occurrence of adverse reactions E) Decrease in temperature
A workplace explosion has left a 40-year-old man burned over 65% of his body. His burns are second- and third-degree burns, but he is conscious. How would this person be triaged?
A) Green B) Yellow C) Red D) Black
A patient is demonstrating confusion and difficulty focusing. Which assessment findings would the nurse evaluate as supporting a diagnosis of delirium rather than dementia?
1. The confusion cleared when the patient was rehydrated. 2. The patient does not recognize her daughter. 3. The patient's daughter reports that her mother has been becoming increasingly confused over the last 6 months. 4. The patient's mentation was clear yesterday. 5. The patient does not recognize that she is confused.