1 1he nurse |s ass|st|ng |n p|ann|ng care

for a c||ent w|th a d|agnos|s of |mmune

def|c|ency 1he nurse wou|d |ncorporate
wh|ch of the ff as a pr|or|ty |n the p|an of
care?
A provldlng emoLlonal supporL Lo
decrease fear
8 proLecLlng Lhe cllenL from lnfecLlon
C encouraglng dlscusslon abouL llfesLyle
changes
u ldenLlfylng facLors LhaL decreased Lhe
lmmune funcLlon
1 Answer (8) protect|ng the c||ent
from |nfect|on
mmunodeflclency ls an absenL or
depressed lmmune response LhaL
lncreases suscepLlblllLy Lo lnfecLlon So lL ls
Lhe nurse's prlmary responslblllLy Lo
proLecL Lhe paLlenL from lnfecLlon
W Ioey |s a 46 yearo|d rad|o techn|c|an who |s
adm|tted because of m||d chest pa|n ne |s S feet 8
|nches ta|| and we|ghs 190 pounds ne |s d|agnosed
w|th a myocard|a| |nfarct Morph|ne su|fate
D|azepam (Va||um) and L|doca|ne are prescr|bed
W 1he phys|c|an orders 8 mg of Morph|ne Su|fate to be
g|ven IV 1he v|a| on hand |s |abe|ed 1 m|] 10 mg 1he
nurse shou|d adm|n|ster
W A 8 mlnlms
8 10 mlnlms
C 12 mlnlms
u 13 mlnlms
W 2 Answer (C) 1 m|n|ms
Dslng raLlo and proporLlon 8 mg/10 mg x
mlnlms/13 mlnlms 10 x 120 x 12 mlnlms
1he nurse wlll admlnlsLer 12 mlnlms
lnLravenously equlvalenL Lo 8mg Morphlne
SulfaLe
W Ioey asks the nurse why he |s rece|v|ng the
|n[ect|on of Morph|ne after he was
hosp|ta||zed for severe ang|na| pa|n 1he
nurse rep||es that |t
W A Wlll help prevenL erraLlc hearL beaLs
8 8elleves paln and decreases level of anxleLy
C uecreases anxleLy
u ullaLes coronary blood vessels
W Answer (8) ke||eves pa|n and decreases
|eve| of anx|ety
Morphlne ls a speclflc cenLral nervous sysLem
depressanL used Lo relleve Lhe paln assoclaLed
wlLh myocardlal lnfarcLlon L also decreases
anxleLy and apprehenslon and prevenLs
cardlogenlc shock by decreaslng myocardlal
oxygen demand
W 4 Cxygen L]m|n by nasa| cannu|a |s
prescr|bed for Ioey who |s adm|tted to the
hosp|ta| for chest pa|n 1he nurse |nst|tutes
safety precaut|ons |n the room because
oxygen
W A ConverLs Lo an alLernaLe form of maLLer
8 Pas unsLable properLles
C SupporLs combusLlon
u s flammable
W Answer (C) Supports combust|on
1he nurse should know LhaL Cxygen ls
necessary Lo produce flre Lhus precauLlonary
measures are lmporLanL regardlng lLs use
W S Iose who had a myocard|a| |nfarct|on days
ear||er has been comp|a|n|ng to the nurse about
|ssues re|ated to h|s hosp|ta| stay 1he best |n|t|a|
nurs|ng response wou|d be to
W A Allow hlm Lo release hls feellngs and Lhen leave hlm
alone Lo allow hlm Lo regaln hls composure
8 8efocus Lhe conversaLlon on hls fears frusLraLlons
and anger abouL hls condlLlon
C Lxplaln how hls belng upseL dangerously dlsLurbs hls
need for resL
u ALLempL Lo explaln Lhe purpose of dlfferenL hosplLal
rouLlnes
W 3 Answer (8) kefocus the conversat|on on h|s
fears frustrat|ons and anger about h|s cond|t|on
1hls provldes Lhe opporLunlLy for Lhe cllenL Lo
verballze feellngs underlylng behavlor and helpful
ln rellevlng anxleLy AnxleLy can be a sLressor
whlch can acLlvaLe Lhe sympaLhoadrenal
response causlng Lhe release of caLecholamlnes
LhaL can lncrease cardlac conLracLlllLy and
workload LhaL can furLher lncrease myocardlal
oxygen demand