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A nurse is caring for a client in the ICU

Exhibits

For each potential nursing action, click to specify if the action is essential, nonessential, or contraindicated for the client.

A.

Administer furosemide

B.

Administer ordered Epinephrine drip

C.

Administer ordered low dose dopamine

D.

Insert an indwelling urinary catheter.

E.

Administer ordered nitroglycerin

F.

Administed 0.9% NS 500ML bolus

Answer and Explanation

The Correct Answer is {"A":{"answers":"A"},"B":{"answers":"A"},"C":{"answers":"A"},"D":{"answers":"A"},"E":{"answers":"B"},"F":{"answers":"A"}}

  • Administer furosemide: The patient has signs of pulmonary edema which needs to be managed.
  • Administer ordered Epinephrine drip: Epinephrine is crucial for managing hemodynamic instability.
  • Insert an indwelling urinary catheter: Monitoring urine output helps assess kidney function and fluid balance.
  • Administer ordered low dose dopamine: Useful for maintaining renal perfusion and blood pressure.
  • Administered 0.9% NS 500 mL bolus: Helps address hypotension and volume deficit.
  • Administer ordered nitroglycerin: Not needed in this acute post-arrest phase unless specifically indicated for managing ongoing angina or heart failure symptoms.


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Related Questions

Correct Answer is B

Explanation

A. Learning to control impulsive behavior is more relevant for a right hemispheric CVA, which affects impulse control and judgment.

B. Establishing the ability to communicate effectively is crucial for a left hemispheric CVA, which often affects language and speech functions.

C. Compensating for loss of depth perception is related to right hemispheric CVA, which affects spatial awareness and perception.

D. Improving left-side motor function is important but secondary to addressing communication issues in a left hemispheric CVA where language deficits are a priority.

Correct Answer is B

Explanation

A. Blockage of the ET tube by the client's tongue would not typically result in asymmetric chest wall expansion.
B. If the ET tube has moved into the right main bronchus, it will cause more air to enter the right lung and less to the left, leading to decreased left-sided chest wall expansion.
C. Infection of the vocal cords is not related to the absence of chest wall expansion.
D. Passage of the ET tube into the esophagus would lead to the absence of breath sounds in both lungs, not just the left side.

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