A nurse is caring for several clients at risk for shock. Which ...

[SO00]

A nurse is caring for several clients at risk for shock. Which laboratory value requires the nurse to communicate with the health care provider?
 
  a. Creatinine: 0.9 mg/dL
  b. Lactate: 6 mmol/L
  c. Sodium: 150 mEq/L
  d. White blood cell count: 11,000/mm3

Question 2

A client in shock is apprehensive and slightly confused. What action by the nurse is best?
 
  a. Offer to remain with the client for awhile.
  b. Prepare to administer antianxiety medication.
  c. Raise all four siderails on the client's bed.
  d. Tell the client everything possible is being done.

[sylvia]

Answer to Question 1

ANS: B
A lactate level of 6 mmol/L is high and is indicative of possible shock. A creatinine level of 0.9 mg/dL is normal. A sodium level of 150 mEq/L is high, but that is not related directly to shock. A white blood cell count of 11,000/mm3 is slightly high but is not as critical as the lactate level.

Answer to Question 2

ANS: A
The nurse's presence will be best to reassure this client. Antianxiety medication is not warranted as this will lower the client's blood pressure. Using all four siderails on a hospital bed is considered a restraint in most facilities, although the nurse should ensure the client's safety. Telling a confused client that everything is being done is not the most helpful response.

[SO00]

TYSM

[bdobbins]

Excellent