The nurse entering the client's room notes that the client is ...

[Diane]

The nurse entering the client's room notes that the client is sweating and appears to be pale and gasping. The initial action by the nurse is to:
 
  1. Assess the client.
   2. Notify the physician.
   3. Administer 10L of oxygen per nasal cannula.
   4. Reposition the client.

Question 2

The spouse of a client being treated for depression tells the nurse that she does not believe the client is responding to the medication. Which of the following responses should the nurse make to the spouse?
 
  1. Stop the medication immediately..
   2. Stay on the medication for 6 months to see if there is a response..
   3. A trial and error period is the best way to determine which medication is the most effective..
   4. Learn to live with the depression..

[jaykayy05]

Answer to Question 1

1. Assess the client.

Rationale:
The first step in any decision process is assessment. The client is indeed experiencing difficulty, but the nurse needs to assess the extent of the need and the reason for the problem before taking action. The physician will ask the nurse to identify the reason for the problem and the extent of the problem. Administering oxygen could be deleterious to the client in some cases, such as if the client has chronic obstructive pulmonary disease. Oxygen may not be helpful. The client may have simply slipped down in the bed and need repositioning; on the other hand, the client may be in trouble, so making the decision to simply reposition the client without assessment could cause harm.

Answer to Question 2

3. A trial and error period is the best way to determine which medication is the most effective..

Rationale:
A trial and error period may be needed to determine what medication is best for the person. About 30 of clients do not respond to their antidepressant in a trial of four to six weeks. Do not stop medications without notification of the prescriber. Antidepressant medication is often prescribed for clients with depression symptoms. Stating that the spouse will have to learn to live with the depression is inappropriate.

[Diane]

TYSM

[amandanbreshears]

Excellent