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Evolve Question Thermoregulation

1.

A new registered nurse (RN) is assigned to the care of a client hospitalized with a diagnosis of hypothermia. After consulting with an experienced RN, which statement by the new RN indicates understanding of likely assessment findings for this client?

1.Increased heart rate and increased blood pressure

2.Increased heart rate and decreased blood pressure

3.Decreased heart rate and increased blood pressure

4.Decreased heart rate and decreased blood pressure

4.Decreased heart rate and decreased blood pressure

2.

A new registered nurse (RN) is assisting the RN in admitting a client who has a diagnosis of hypothermia. The RN provides education to the new RN on anticipated vital signs in the client with hypothermia. Which statement by the new RN indicates that the teaching has been effective?

1."The client will likely exhibit increased heart rate and increased blood pressure."

2."The client will likely exhibit increased heart rate and decreased blood pressure."

3."The client will likely exhibit decreased heart rate and increased blood pressure."

4."The client will likely exhibit decreased heart rate and decreased blood pressure."

4."The client will likely exhibit decreased heart rate and decreased blood pressure."

3.

A client with a neurological problem is experiencing hyperthermia. Which measures would be appropriate for the nurse to use in trying to lower the client's body temperature? Select all that apply.

1.Giving tepid sponge baths

2.Applying a hypothermia blanket

3.Covering the client with blankets

4.Administering acetaminophen per protocol

5.Placing ice packs over the client's abdomen and in the axilla and groin

1.Giving tepid sponge baths

2.Applying a hypothermia blanket

4.Administering acetaminophen per protocol

4.

The nurse is developing a plan of care for an older client that addresses interventions to prevent cold discomfort and the development of accidental hypothermia. The nurse would document which desired outcome in the plan of care?

1.The client's fingers and toes are warm to touch.

2.The client's body temperature is 96.7° F (35.9° C).

3.The client remains in a fetal position when in bed.

4.The client complains of coolness in the hands and feet only.

1.The client's fingers and toes are warm to touch.

5.

The nurse is caring for an unconscious client who is experiencing persistent hyperthermia with no signs of infection. On the basis of these findings the nurse suspects dysfunction in which area of the brain?

1.Cerebrum

2.Cerebellum

3.Hippocampus

4.Hypothalamus

4.Hypothalamus

6.

The nurse has a prescription to administer a medication to a client who is experiencing shivering as a result of hyperthermia. Which medication would the nurse anticipate to be prescribed?

1.Buspirone

2.Fluphenazine

3.Chlorpromazine

4.Prochlorperazine

3.Chlorpromazine

7.

A client treated for an episode of hyperthermia is being discharged to home. The nurse determines that the client needs clarification of discharge instructions if the client states a need to perform which action?

1.Increase fluid intake.

2.Resume full activity level.

3.Stay in a cool environment when possible.

4.Monitor voiding for adequacy of urine output.

2.Resume full activity level.

8.

A client arrives at the postpartum unit after delivery of an infant. On performing an assessment, the nurse notes that the client is shaking uncontrollably. Which nursing action is appropriate?

1.Massage the fundus.

2.Cover the client with a warm blanket.

3.Place the client in Trendelenburg's position.

4.Contact the primary health care provider (PHCP).

2.Cover the client with a warm blanket.

9.

The nurse has an order for therapeutic hypothermia for a client following a cardiac arrest. Which findings indicate that the treatment is effective?

1.The client is shivering.

2.The client is no longer having seizure activity.

3.The IV fluids are maintained at a cool temperature.

4.The client’s mean arterial pressure (MAP) is maintained at 80 mm Hg.

4.The client’s mean arterial pressure (MAP) is maintained at 80 mm Hg.

10.

The nurse assisted with the birth of a newborn. Which nursing action is most effective in preventing heat loss by evaporation?

1.Warming the crib pad

2.Closing the doors to the room

3.Drying the infant with a warm blanket

4.Turning on the overhead radiant warmer

3.Drying the infant with a warm blanket