Author Question: After completing a thorough database and carrying out nursing interventions based on priority ... (Read 48 times)

jwb375 · **on:** Jul 22, 2018

After completing a thorough database and carrying out nursing interventions based on priority diagnoses, the nurse proceeds to which step of the nursing process?

a. Assessment
b. Planning
c. Implementation
d. Evaluation

Question 2

In the nursery, the nurse is taking the newborn's vital signs. The nurse compares the newborn's measurements with which of the following expected values for this age group?

a. Heart rate, 140 beats per minute; blood pressure, 72/44 mm Hg; respiratory rate, 46 breaths per minute
b. Heart rate, 100 beats per minute; blood pressure, 90/50 mm Hg; respiratory rate, 24 breaths per minute
c. Heart rate, 90 beats per minute; blood pressure, 100/60 mm Hg; respiratory rate, 20 breaths per minute
d. Heart rate, 80 beats per minute; blood pressure, 100/70 mm Hg; respiratory rate, 16 breaths per minute

DylanD1323 · **Reply #1 on:** Jul 22, 2018

Answer to Question 1

D
In the five-step nursing process, evaluation is the last step following assessment, diagnosis, planning, and intervening. Assessment involves gathering information about the patient. Next, nursing diagnoses are determined. During the planning phase, patient outcomes are determined. Implementation involves carrying out appropriate nursing interventions.

Answer to Question 2

A

Feedback
A The expected values for the newborn's vital signs are heart rate, 120 to 160 beats per minute; blood pressure, 85/54 mm Hg, and respiratory rate 30 to 60 breaths per minute. This option demonstrates values within the normal range.
B In the option, heart rate, 100 beats per minute; blood pressure, 90/50 mm Hg; respiratory rate, 24 breaths per minute, the heart and respiratory rates are too low and the blood pressure too high for a newborn. These would be normal vital signs for a toddler.
C In the option, heart rate, 90 beats per minute; blood pressure, 100/60 mm Hg; respiratory rate, 20 breaths per minute, the heart and respiratory rates are too low and the blood pressure too high for a newborn. These vital signs are more consistent with the normal range for a preschooler.
D In the option, Heart rate, 80 beats per minute; blood pressure, 100/70 mm Hg; respiratory rate, 16 breaths per minute, the heart and respiratory rates are too low and the blood pressure too high for a newborn. These vital signs are more consistent with the normal findings for a school-age child.