Perfusion
What are assessment findings in a person with poor perfusion?
Edema
slow capillary refill
cool body temperature
A client is confused and it has progressed significantly. Which would be priority for this client?
Safety
The nurse needs to assess the oxygen status of a client who is suddenly experiencing shortness of breath. What is the most appropriate noninvasive measurement technique?
Pulse oximeter
Describe the function of fibrinogen.
Plays a key role in forming blood clots.
Which diagnostic test would be used if a malignancy is suspected?
Biopsy
What are assessment findings in a person with good perfusion?
Pink warm skin
normal heart rate
good capillary refill
What major complication is associated with oral intake in the client with a decreased level of consciousness?
The nurse is caring for a client with an altered level of consciousness. What action is the priority for this client?
Maintain a clear airway to ensure adequate ventilation.
What are assessment findings in a person with excessive clotting?
Swelling, heat, redness, pain, enlarged spleen, respiratory distress, change in LOC, poor perfusion.
Which is the primary preventable cause of skin cancer
Exposure to UV radiation
Indicates how much pressure the blood is exerting against the arterial wall. Maximum blood pressure during contraction of the ventricles.
Systolic pressure
What is the term for loss of ability to understand or express speech, caused by brain damage?
Aphasia
Give 3 examples of how children are different than adults.
Natural nose breathers
Respiration rate is higher
Need humidity when pushing O2 because kids produce less surfactant than adults
The nurse is aware that which of the following nutrients promotes normal blood clotting?
Vitamin K
What is the term for inflammation of mouth or gut?
Mucositis
Give 3 examples of how children are different than adults.
Sweating is a sign of cardiovascular disease
Poor feeding/eating habits
falling asleep during feedings/fatigue
The nurse is assessing a client’s cognitive capabilities. What will the nurse assess to determine if the client is cognitively intact?
Speech, abstract reasoning, judgment, memory.
The nurse is called into a toddler’s room. The toddler’s parent says “my toddler is having trouble breathing.” what is the priority nursing action?
Assess patency of the child’s airway.
About 10 days after giving birth, a new mother visits her primary care provider with localized symptoms of redness, swelling , warmth, and a hard, inflamed vessel in one leg. The nurse should suspect which condition?
Excessive clotting
What is the rationale for asking the client whether they have noticed any new or changed moles?
Changes in existing moles or the appearance of new moles can indicate melanoma
Labs that can be ordered
lipid panel, CRP, Troponin, BNP
A nurse is planning hygiene for a client who is confused. The nurse understands the need to provide an environment that will aid her in the care of this client. What is the priority nursing action?
Create a calming environment with little stimuli.
The nurse is caring for a client who has been prescribed 8L/minute of oxygen by the provider. Which oxygen delivery device with the nurse consider using?
Simple mask
The nurse is caring for a client with ineffective clotting who states they have pain in both knees that began this week. The nurse notes bruises on both knees. Based on the ineffective clotting and the report of pain, what does the nurse suspect is the cause of the pain?
Bleeding
A nurse is assessing a client who has just been admitted to the postsurgical unit following surgical resection for the treatment of oropharyngeal cancer. What assessment should the nurse prioritize?
Assess for a patent airway.