The nurse is caring for a patient with long-standing bronchiectasis. Which manifestation should the nurse report immediately?
a. Copious sputum
b. Periodic episodes of harsh coughing
c. Distended neck veins and dependent edema
d. Fever of 100.6°F (approximately 38°C) and dyspnea
ANS: C
Distended neck veins and dependent edema are signs of cor pulmonale and should be reported immediately. A. B. D. Fever, sputum, and cough are expected in patients with bronchiectasis.
You might also like to view...
A client with an allergic disorder has received the first sensitizing dose. Now the client is given a second dose of a new drug. Which of the following nursing actions is most important at this stage of transition?
A) Assess the client for reduced urine output. B) Monitor the client for reactions. C) Assess the client for reduced appetite. D) Monitor the client for increased heart rate.
The nurse is providing community education at the mall. The nurse is instructing on the muscular tube that connects the mouth to the stomach. The nurse outlines this structure on a drawing and labels it with which of the following?
A) Pharynx B) Pylorus C) Esophagus D) Ileum
The nurse assesses for which clinical manifestations in the client with suspected encephalitis?
a. Fever of 101° F (38.3° C) b. Nausea and vomiting c. Hypoactive deep tendon reflexes d. Pain on flexion of the neck
A nurse in a community mental health center receives a call asking for information about a patient. Under which condition can the nurse release information to the caller?
a. The caller is related to the patient. b. The psychiatrist approves the request. c. The caller is a mental health professional. d. The patient has given written consent for release of information.