The nurse is evaluating a client who is complaining of shortness of breath. The client's respiratory rate is 26 breaths per minute so the nurse documents that he is tachypneic. The nurse understands that tachypnea means
A. frequent bowel sounds.
B. heart rate greater than 100 beats/minute
C. hyperventilation.
D. respiratory rate greater than 20 breaths/minute
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The physician prescribes several drugs for a client with hemorrhagic stroke. Which drug order should the nurse question
A. Heparin sodium (Hep-Lock).
B. Dexamethasone (Deeadron).
C. Methyldopa (Aldomet).
D. Phenytoin (Dilantin).
Which statement about fluid replacement is accurate for a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS)
Administer 2 to 3 L of IV fluid rapidly.
B. Administer 6 L of IV fluid over the first 24 hours.
C. Administer a dextrose solution containing normal saline solution.
D. Administer IV fluid slowly to prevent circulatory overload and collapse.
While assessing a 2-month-old child's airway, the nurse finds that the child isn't breathing. After two unsuccessful attempts to establish an airway, the nurse should
A. attempt rescue breaths.
B. attempt to reposition the airway a third time.
C. administer five back blows.
D. attempt to ventilate with a handheld resuscitation bag.
When planning care for a 7-year-old boy with Down syndrome, the nurse should
A. plan interventions at the developmental level of a 7-year-old child because that is the child's age.
B. plan interventions at the developmental level of a 5-year-old because the child will have developmental delays.
C. assess the child's current developmental level and plan care accordingly.
D. direct all teaching to the parents because the child can't understand.
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