An 18 month old child is admitted with signs of increased intracranial pressure. What would the nurse observe when assessing this patient? Numbness of fingers and decreased temperature Increased pulse rate and decreased blood pressure Decrease level of consciousness and decreased respiratory rate Decreased level of consciousness and increased respiratory rate
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- An 18 month old child is admitted with signs of increased intracranial pressure. What would the nurse observe when assessing this patient?
Numbness of fingers and decreased temperature
Increased pulse rate and decreased blood pressure
Decrease level of consciousness and decreased respiratory rate
Decreased level of consciousness and increased respiratory rate
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Solved in 2 steps
- A/An _______________ is performed to gain access to the brain or to relieve intracranial pressure.A patient is recovering from general anesthesia. What is the nurse’s main concern during the immediate postoperative period? a )Airway b )Pupillary reflexes c )Return of sensations d )Level of consciousnessWhile 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 client who is scheduled for a bronchoscopy in the morning is anxious and asking the nurse numerous questions about the procedure. In preparing the client for the procedure, which intervention has the highest priority? Allow client to gargle with warm salt water. Administer a sedative to alleviate anxiety. Instruct client to write down the questions. Deny client's request for a midnight snack.the practical nurse (pn) is monitoring a clients neurological status following a closed head injury. Which assessments should the PN include? Select all that apply A Vital sign measurement. B Carotid pulse rate. C Consciousness level. D Jugular vein distention. E Pupillary reactions.A client with renal lithiasis is receiving morphine sulfate every four hours for pain and renal colic. Which assessment finding should prompt the nurse to administer a PRN dose of naloxone? A. Unresponsive to verbal or tactile stimuli. B. Respiratory rate of 12 breath/minute. C. Statements about visual hallucinations. D. Complaints of increasing flank pain.
- The EMT transports a 56 year old male to the ER, he is unconscious when he arrives. The EMT reports that the patient was in the grocery store when he abruptly fell to the ground. The EMT noted he was displayed generalized tonic- clonic seizure symptoms. The ER nurse was unable to get a history. He was unresponsive to commands and seemed very confused. His BP was 175/92, pulse 107, temp. 37.5 C , and his respiratory rate was 19 breaths per min. His pupils were 3mm and reactive, diminished movement on his left side and he had bilateral Babinski reflexes. What is a Generalized tonic-clonic seizures? Seizure disorders are produced by what underlying causes, and which one might you expect in this patient? This patient seizures pathophysiology is probably what?The nurse asks you to obtain a complete set of vital signs for one of the persons to whom you are assigned. Upon measurement, you determine the following: temperature 38.6°C (101.5°F), heart rate 104 beats/min, respiratory rate 22 breaths/min, and blood pressure 90/60 mm Hg. Which of these vital signs are of concern? What subjective data could be stated by the client? What is your first action after collecting these vital signs?1. The nurse is providing education to a 26-year-old female about the procedure she will have in the morning. The nurse notes that the patient is restless and her respirations have increased. The patient is having problems listening and seems irritable. What action should the nurse take first? a.Use therapeutic communication to find the source of anxiety, and provide education b.Inform the charge nurse immediately, that the patient needs a STAT EKG c.Administer Lorazepam, and help the patient sleep d.Call the physician immediately, the patient is having a pulmonary embolism 2. An obese 55-year-old male is about to be transported to the cath lab for an angiography. Which of the following would be important for the nurse to ask before calling report to the cath lab nurse? a. Do you have any allergies, and are you allergic to shellfish? b. Did you remain NPO for at least 2 hours? c. Do you have a history of coronary artery disease? d. Do you have any metal in your body? 3. A MedSurg…
- An elderly patient, only partially responsive on admission, has family present most of the time. Family members continue to ask questions of the healthcare providers, insisting on knowing the patient's condition and his future options. What are the responsibilities of healthcare providers to the family members? Do the family members have a right to know their relative's exact condition? Does HIPAA apply in this situation?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 bpmWhich of the following would the nurse expect to see in client experiencing hypoventilation? increased oxygenation in the alveoli increased carbon dioxide in the bloodstream decreased hemoglobin in the bloodstream decreased carbon dioxide in the alveoli