Drowning in very cold water causes a worse outcome for the client than drowning in warmer water. Aspiration of both salt and fresh water increases surfactant in the lungs and leads to increased lung compliance. If possible, the cause of drowning should be determined in order to know if the client suffered a medical condition…
A client is 2 hours post-op for a right total knee replacement. Upon assessment by the nurse, which information requires notification of the doctor?
hemoglobin is 10.2 grams per liter bleeding on the dressing of 2 cm oral temperature of 100.4°F complaint of pain at incision site
A client with third- and fourth-degree burns is in the burn unit. The nurse understands that which of the following is true regarding fluid shift in burn clients?
The fluid shift can cause hypokalemia and hypovolemia. Hemoconcentration increases blood flow and reduces blood viscosity. Excessive weight loss can occur during the first 12 hours post burn due to the fluid shift. Severe edema can occur in areas that were not burned, due to the leakage of electrolytes and fluids from the vascular space.
The nurse is seeing a client in the clinic who complains of a sore throat. The client asks for an antibiotic. How should the nurse respond?
“You can try gargling with warm saline to relieve the discomfort.” “ You should use a dehumidifier to dry out the air, which will soothe the throat.” “Most sore throats are caused by viruses, which cannot be treated with antibiotics.” “There are three or four antibiotics that we prescribe for a sore throat, so the doctor…
A student nurse is precepting on the cardiac unit with the charge nurse. The charge nurse is educating the student about heart sounds and asks the student nurse to describe what causes the S1 sound. Which response by the student nurse reflects an understanding of cardiac sounds?
“It is caused by the mitral and tricuspid valves closing.” “It is caused by the mitral and pulmonic valves closing.” “It is caused by the pulmonic and aortic valves closing.” “It is caused by the aortic and tricuspid valves closing.”
The nurse is caring for a client in the cardiac unit who has a systolic murmur. Which assessment finding would the nurse expect when auscultating this client’s heart sounds?
The murmur can be heard between S3 and S4. The murmur can be heard between S4 and S1. The murmur can be heard between S2 and S1. The murmur can be heard between S1 and S2.
The nurse is caring for a client with vitamin B12 deficiency anemia. Which physical assessment finding would the nurse expect to note in this client?
glossitis paresthesias weakness and pallor dark purple or cyanotic skin on the face and mucous membranes
A nurse is providing pre-op teaching to a client who will be undergoing a coronary artery bypass graft. Which of the following should the nurse include in the teaching?
“Your medications will be changed after surgery.” “You will be on strict bed rest for the first 48 hours.” “You will be using a bedpan after surgery to urinate.” “You will need to splint the chest incision when you cough or breathe deeply.” “You will be on the ventilator after surgery and have one or…
The nurse is discussing various oxygen delivery systems with a newly graduated nurse who has just begun working on the medical floor. Which statement by the student nurse indicates an understanding of the different oxygen delivery systems?
“A tracheostomy collar requires a flow rate of at least 6 L/minute to be effective.” “High-flow oxygen delivery systems include the venturi mask, face tent, and non-rebreather masks.” “The non-rebreather mask should receive a high enough flow rate to keep the reservoir bag completely full.” “Nasal cannulas, non-rebreather masks, simple face masks, and partial rebreather…