Virginia Admitted That She Had Been Straining While Seated on the Toilet

question 14

Multiple Choice

Virginia admitted that she had been straining while seated on the toilet and the anesthesia provider and perianesthesia nurse surmised that Virginia experienced a vagal response,which led to bradycardia and syncope (fainting) .While Virginia feels weak and tired from her experience,she is eager to go home and pleads to be discharged.Her heart rate and blood pressure are less than 20% of her admission parameters;she is awake and lucid and is able to appropriately follow commands.Her incision and dressings are intact and her abdomen is soft.She claims that her pain is slight and tolerable.The nurse must now determine the next step in Virginia's recovery based on this recent evaluation.What phase of the nursing process will impact Virginia's next step and what can she expect?

• A) The assessment phase will pursue laboratory diagnostic chemistry panels and arterial blood gases to determine oxygenation and potential for internal bleeding.
• B) The planning phase will review her current vital signs and symptoms compared to admission values,and she will continue to be monitored with IV fluids.
• C) The implementation phase will administer a titrated IV atropine until her blood pressure and heart rate are at or above preadmission values.
• D) The evaluation phase supports a period of watchful waiting while she receives IV fluids and sips juice.

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Definitions:

Reasoning

The drawing of conclusions or inferences from observations, facts, or assumptions.

Framing

The way information is presented to users, which can influence decision-making and judgment by highlighting certain aspects while excluding others.

Reflective Judgment

The process of critically evaluating the validity of various propositions or hypotheses.

Prereflective Thinking

A level of cognition occurring without conscious awareness or reflection on the thought process itself.