Quiz 2 Flashcards
(16 cards)
during a BP screening an older patient tells the nurse about chest fluttering while doing yard work. the patient reports no other symptoms and the frequency is intermittent. the nurse would interpret this finding to be consistent with
underlying illness that requires a medical eval
the nurse is assessing an older patient with a cardiac dysrhythmia. what finding would the nurse identify as contributing to the patients dysrhythmia
drinks caffeinated coffee in the morning and for lunch
which of the following should the nurse do to assist a patient with paroxysmal supraventricular tachy
prepare for cardioversion
administer IV adenosine
admin a beta blocker
a patient admitted with a cardiac dysrhythmia reports being easily fatigued and frustrated with the inability to perform ADLs. the nursing diagnosis to address the patient’s issue is
activity intolerance
when planning care for a pt admitted with a cardiac dysrhythmia, what should the nurse include
monitor serum electrolyte levels
a client is recieving procainamide hyprochloride for treatment of a dysrhythmia. which of the following indicates the patient is adhering to the provided med instruction
the patient will take the med as directed even when feeling well
what will the nurse most likely assess in a patient diagnosed with DIC
confusion
tachy
decreased breath sounds
the nurse is planning an educational program to instruct patients on DIC. what should the nurse include as risk factors for this health problem
prolonged retention of a fetus after demise
abruptio placentae
a pt with DIC is anxious and has decreased oxygen sat. the nursing diagnosis appropriate for the patient at this time is
impaired gas exchange
***the decrease in oxygen sat is causing an impairment in the patient’s gas exchange
a client w/ a head injury from an automobile accident is in the ICU with ICP the priority nursing intervention for the client with increasing ICP is
ensuring adequate oxygenation
the nurse has formulated a nursing dx of interrupted family processes for the family of a patient who sustained a brain injury during an automobile accident. which of the following interventions planned by the nurse would have the highest priority
encourage the family to ask questions and express feelings
a client is being monitored for ICP, using the monro kellie hypothesis as a basis for explanantion, the nurse makes which comment to the client’s family
increasing brain pressure decreases the amount of blood flow to the brain itself
unresponsive, may moan with deep stimuli
semicomatose
easily bewildered, slow to respond
confusion
unresponsive, posturing with deep stimuli
comatose
not oriented to person place time situation
disoriented
