A patient with a ventro-peritoneal shunt is developing increased intracranial pressure (ICP). Which symptoms would the nurse associate with this?
• Early signs of increased intracranial pressure include
• Late signs of intracranial pressure include alteration in pupil size and reactivity, decorticate or decerebrate posturing, and the Cushing's Triad: widening pulse pressure, bradycardia, and a change in respirations.
The nurse is assessing a patient after she underwent a renal arteriogram. The nurse is palpating the right groin access site for complications when the patient suddenly complains of right calf pain. What should the nurse do first?
The nurse collects a urine sample from a patient with pyelonephritis. After the lab has completed the urinalysis, the nurse would expect which of the following abnormalities consistent with pyelonephritis?
A client who underwent a pneumonectomy has the nursing diagnosis of ineffective airway clearance related to increased secretions and decreased coughing effectiveness due to pain. Which of the following interventions can help the client achieve effective airway clearance?
A patient's chest x-ray indicates acute respiratory distress syndrome (ARDS). The nurse understands that this condition results from
A patient is admitted to the hospital for respiratory distress. The nurse suspects pneumonia because of the presence of which of the following?
The nurse is caring for a patient suspected of having a pulmonary embolism. The patient complains of chest pain and a low-grade fever. Which of the following signs and symptoms would support this diagnosis?
A woman undergoing chemotherapy treatment for uterine cancer asks the nurse how chemotherapeutic medications help treat her cancer. Which of the following statements by the nurse is accurate?
A 59-year-old patient was advised to have a prostate-specific antigen blood test. After the PSA screening test was done, the patient asked the nurse what factors increase the risk of prostate cancer. The nurse correctly responds by saying which of the following?
While caring for a patient with severe heart failure and coronary artery disease, the nurse understands that her patient's decreased preload could be caused by
A patient is admitted to the cardiac unit with endocarditis. The patient asks how someone catches this illness. Which of the following should the
The nurse is caring for a patient who underwent a thyroidectomy. Which of the following items should the nurse keep at the patient's bedside?
The nurse is performing a physical assessment on a patient with congestive heart failure (CHF). The nurse notes pitting edema and documents it as 2+ edema. Which of the following descriptions best defines 2+ edema?
A client, diagnosed with insulin-dependent diabetes and acute heart failure, was admitted to the hospital for medical management. What are the appropriate pharmacological interventions to help reduce myocardial workload and improve ventricular pump performance?
The nurse is assessing a new admission, a patient with fluid volume deficit. To aid in gathering further information about the patient's hydration status, the nurse will
A newly admitted patient has sustained deep partial-thickness burns to the face and trunk. Which of the following abnormal values can the nurse expect during the emergent phase?
A patient with psoriasis is prescribed ultraviolet light therapy. After providing instructions, the nurse determines that the patient requires additional instruction based on which of these statements?
A patient with necrotizing fasciitis will be undergoing a skin graft surgery. Which of the following patient statements indicates that informed consent has not been obtained?
A patient comes in for a follow-up evaluation of partial-thickness burns of the thighs. The patient claims to wash the wounds and change the dressings every day. When the nurse assesses the patient's wounds, the nurse notes the patient is not wearing dressings and that the wounds are covered in dirt. How should the nurse
In a patient with hypothyroidism, which clinical manifestation would be indicative of right-sided heart failure?
A patient recovering from a myocardial infarction has been in bed for 6 days. The patient now complains of calf pain. The nurse should first
While caring for a patient after shoulder arthroplasty, the nurse assesses for brachial plexus compromise by doing which of the following ulnar nerve tests?
The nurse is teaching an
The nurse is administering several scheduled medications to a patient with acute renal failure. The nurse should frequently assess the patient for: