A nurse is caring for a client who has burns to his face, ears, and eyelids. The nurse should identify which of the following is the priority finding to report to the provider?
Difficulty swallowing
Urinary output 25 mL/hr
Heart rate 122/min
Pain of 6 on a scale of 0 to 10
The Correct Answer is A
Difficulty swallowing is the priority finding to report to the provider. Rationale: This is because difficulty swallowing can indicate airway edema, which can compromise breathing and oxygenation. The nurse should monitor the client's respiratory status and administer oxygen as prescribed. The other findings are also important, but not as urgent as airway obstruction.
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Related Questions
Correct Answer is ["A","C","D","E","F"]
Explanation
- Disorientation may indicate hypoxia, infection, or medication side effects. - Yellow sputum may indicate a bacterial infection that requires antibiotics. - Nebulizer use may indicate that the client is not using it correctly or regularly as prescribed, which can affect their lung function and oxygenation. - Ankle edema may indicate fluid overload or heart failure, which can worsen COPD symptoms and increase the risk of complications.
- Living alone may pose safety risks for the client, especially if they are disoriented or have difficulty managing their oxygen and nebulizer treatments. The nurse should assess the client's support system and refer them to community resources if needed.
Correct Answer is A
Explanation
This is because SLE is an autoimmune disorder that causes inflammation and damage to various organs and tissues, such as the skin, joints, kidneys, heart, and blood vessels. Connective tissue is a type of tissue that supports and binds other tissues and organs in the body.
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