The nurse is assessing the respirations ol a client with chronic obstructive pulmonary disease (COPD). What is the rationale for the nurse to assess the respiratory rate without the client being aware of it? It is more efficient for the nurse to do so because it takes less time Client awareness might alter the respiratory rate or pattern The client might suppress Kussmaul's respirations if aware the respirations are being counted It allows for observation for

The nurse is assessing the respirations ol a client with chronic obstructive pulmonary disease (COPD). What is the rationale for the nurse to assess the respiratory rate without the client being aware of it? It is more efficient for the nurse to do so because it takes less time Client awareness might alter the respiratory rate or pattern The client might suppress Kussmaul's respirations if aware the respirations are being counted It allows for observation for

Comprehensive Medical Assisting: Administrative and Clinical Competencies (MindTap Course List)

6th Edition

ISBN:9781305964792

Author:Wilburta Q. Lindh, Carol D. Tamparo, Barbara M. Dahl, Julie Morris, Cindy Correa

Publisher:Wilburta Q. Lindh, Carol D. Tamparo, Barbara M. Dahl, Julie Morris, Cindy Correa

Chapter8: Emergency Procedures And First Aid

Section: Chapter Questions

Problem 4CR

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While discussing home safety with the nurse, a patient admitsthat she always smokes a cigarette in bed before falling asleepat night. Which nursing diagnosis would be the priority forthis patient?a. Impaired Gas Exchange related to cigarette smokingb. Anxiety related to inability to stop smokingc. Risk for Suffocation related to unfamiliarity with fireprevention guidelinesd. Deficient Knowledge related to lack of follow-through ofrecommendation to stop smoking
A nurse is assessing the vital signs of patients who presentedat the emergency department. Based on the knowledge ofage-related variations in normal vital signs, which patientswould the nurse document as having a normal vital sign?Select all that apply.a. A 4-month old infant whose temperature is 38.1°C(100.5°F)b. A 3-year old whose blood pressure is 118/80c. A 9-year old whose temperature is 39°C (102.2°F)d. An adolescent whose pulse rate is 70 bpme. An adult whose respiratory rate is 20 bpmf. A 72-year old whose pulse rate is 42 bpm
A nurse is monitoring a patient who is receiving an IVinfusion of normal saline. The patient is apprehensive andpresents with a pounding headache, rapid pulse rate, chills,and dyspnea. What would be the nurse’s priority interventionrelated to these symptoms?a. Discontinue the infusion immediately, monitor vitalsigns, and report findings to primary care providerimmediately.b. Slow the rate of infusion, notify the primary care providerimmediately and monitor vital signs.c. Pinch off the catheter or secure the system to prevent entryof air, place the patient in the Trendelenburg position, andcall for assistance.d. Discontinue the infusion immediately, apply warm, moistcompresses to the site, and restart the IV at another site.
At 11 p.m., a patient is admitted to the Emergency Department (ED) with a respiratory rate of 44 breaths/minute and SaO2 85%. They are anxious with audible wheezes. The patient is immediately given nebulised Salbutamol follow by oxygen via face mask and Hydrocortisone intravenously (i.v) Explain the reason for intravenous (JV) Hydrocortisone. . Provide two (2) nursing interventions with rationales to improve airway clearance and/or improve breathing pattern
What is the priority assessment for the nurse to evaluate the effectiveness of the furosemide for this patient? A. Assess breath sounds B. provide incentive spirometer C. begin CPR D. raise the head of the bed E. apply oxygen
A nurse is inserting a nasogastric tube ordered for a patientto monitor bleeding in his GI tract. When the tube is beingpassed through the pharynx, the patient begins to cough andshow signs of respiratory distress. What would be the priorityaction of the nurse upon this assessment?a. Keep the tube in place and notify the primary care providerimmediately.b. Stop advancing the tube and pull it back into the nasalarea.c. Ask the patient if he wants the nurse to stop the procedure.d. Call for help to perform CPR.
A nurse is monitoring an older adult client immediately following a bronchoscopy. The nurse's priority is to monitor the client for which of the following? Observing for confusion Auscultating breath sounds Confirming the gag reflex Measuring blood pressure O ...
Which assessments and interventions should the nurseconsider when performing tracheal suctioning? Selectall that apply.a. Closely assess the patient before, during, and after theprocedure.b. Hyperoxygenate the patient before and aftersuctioning.c. Limit the application of suction to 20 to 30 seconds. d. Monitor the patient’s pulse frequently to detectpotential effects of hypoxia and stimulation of thevagus nerve.e. Use an appropriate suction pressure (80–150 mm Hg).f. Insert the suction catheter no further than 1 cm past thelength of the tracheal or endotracheal tube.
To evaluate the effectiveness of mechanical ventilation for a patient with respiratory failure, which diagnostic will be most useful to the nurse? 1. A chest x-ray 2. Oxygen saturation 3. Arterial blood gas analysis 4. Central venous pressure
A nurse is caring for a client who presented to the emergency department with an acute asthma exacerbation. The respiratory rate is 36 breaths/min, and a pulse oximeter is 85% on room air with accessory muscle use to breathe. The nurse placed the client on oxygen 4 liters nasal cannula. The arterial blood gas (ABG) is as follows: pH: 7.28, PaCO2: 50 mm Hg, PaO2: 75 mm Hg, and HCO3: 26 mEq/L. Which of the following treatments is the nurse's highest priority? A) Administer bronchodilators B) Administer sodium bicarbonate Administer methylprednisolone (D) Perform a chest x-ray
A nurse is preparing to administer codeine 30 mg PO every 4 hr PRN to a client for pain. Theamount available is codeine oral solution 15 mg/5 ml. How many ml should the nurse planto administer per dose? (Round the answer to the nearest whole number. Use a leading zero ifit applies. Do not use a trailing zero.)
What action does the nurse perform to follow safe techniquewhen using a portable oxygen cylinder?a. Checking the amount of oxygen in the cylinder beforeusing itb. Using a cylinder for a patient transfer that indicatesavailable oxygen is 500 psic. Placing the oxygen cylinder on the stretcher next to thepatientd. Discontinuing oxygen flow by turning cylinder keycounterclockwise until tight