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MED SURG II HESI (Elsevier)

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MED SURG II HESI (Elsevier)
A client is admitted for dehydration, and an intravenous (IV) infusion of normal

saline at 125 mL/hr has been started. One hour after the IV initiation the client

begins screaming, "I can't breathe!" The nursing priority action is: - answer

Elevate the head of the bed and obtain vital signs



A nurse is assessing a client with a diagnosis of early left ventricular heart failure.

Specific to this type of heart failure, the nurse expects the client to state: - answer

4. "I have trouble breathing when I walk rapidly



A client who had a myocardial infarction asks the nurse, "What's the chance of my

having another heart attack if I carefully watch my diet and stress levels?" What is

the nurse's most appropriate initial response?



. – answer 1. Focus on the client's feelings by exploring the reason why the

question was asked.



The nurse is assessing a client for signs of right ventricular failure. What should

the nurse expect if this occurs? – answer 3. Neck vein distention

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