Author Question: The nurse begins to auscultate the client's lungs. While listening, the nurse notices fresh bloody ... (Read 145 times)

segrsyd · **on:** Jul 22, 2018

The nurse begins to auscultate the client's lungs. While listening, the nurse notices fresh bloody drainage oozing from the abdominal dressing. The nurse stops auscultating and applies direct pressure to the wound site.

Of what is this nursing action an example? a. Performing a nursing assessment
b. Reorganizing the nursing diagnoses
c. Setting realistic goals and implementing nursing interventions
d. Critically analyzing the data and effectively implementing the safest nursing action

Question 2

The nurse caring for a patient with ischemia to the left coronary artery would expect to find

a. Increased ventricular diastole.
b. Increased stroke volume.
c. Decreased preload.
d. Decreased afterload.

LP · **Reply #1 on:** Jul 22, 2018

Answer to Question 1

D

Feedback
A The nurse is doing more than performing a nursing assessment; the nurse is taking action based on new assessment data.
B The nurse is not reorganizing nursing diagnoses; the nurse is implementing the priority nursing action.
C The scenario is not an example of setting realistic goals and implementing nursing interventions. Applying direct pressure to a wound site to stop bleeding demonstrates critical analysis of the data and implementation of the safest nursing action.
D The nurse who stops auscultating lung sounds to take measures to stop noticeable bleeding is analyzing data presented, as demonstrated by the nurse's setting priorities, and is effectively implementing the safest nursing action.

Answer to Question 2

D
The left coronary artery supplies the muscles of the left ventricle; the strength of the muscle affects the contractility of the heart. The other options are not impacted by the muscles of the left ventricle.