The nurse is taking care of a client with terminal lung cancer ...

[azncindy619]

The nurse is taking care of a client with terminal lung cancer who is showing signs of imminent death. What changes should the nurse expect the client to exhibit?
 
  Select all that apply.
  A) Decreased blood pressure
  B) Initial increased heart rate followed by bradycardia
  C) An increase in the volume of Korotkoff's sounds
  D) Diaphoresis
  E) An increase in cardiac output

Question 2

A nurse is planning care for a client with leukemia. The nurse chooses Risk for Bleeding as the nursing diagnosis. Which interventions support this nursing diagnosis?
 
  Select all that apply.
  A) Educate client in use of soft toothbrush for oral care.
  B) Use non-electric razor when providing grooming for client.
  C) Limit parenteral injections.
  D) Apply pressure to arterial puncture sites for 5 minutes.
  E) Encourage client to deep breathe and huff cough frequently.

[LVPMS]

Answer to Question 1

Answer: A, B, D

The heart rate might initially increase as hypoxia develops; then the heart rate and blood pressure decrease, resulting in decreased cardiac output. Peripheral circulation decreases, leading to diaphoresis; clammy, cool skin; and changes in skin coloring. A change in pulse pressure and a decrease in the volume of Korotkoff's sounds indicate imminent death. The heart rate and blood pressure decrease, resulting in decreased cardiac output, which is a sign of imminent death.

Answer to Question 2

Answer: A, C

The client at risk for bleeding has specific interventions to which the nurse should adhere. The nurse should educate the client in the use of soft toothbrush and the use of an electric razor to avoid bleeding. The nurse should also limit the use of parenteral injections and apply 15-20 minutes of pressure to any arterial puncture sites. The nurse should discourage the client to forcefully cough to prevent further bleeding.

[azncindy619]

Thank you

[LVPMS]

Happy to help you