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Thermoregulation NUR 111

Total questions: 10

Worksheet time: 15mins

Name
Class
Date
1.

A nurse enters the room of a patient who is postoperative day one after abdominal surgery. The patient’s temperature is 101.8°F (38.8°C), respiratory rate 24, and the patient appears slightly restless. Which action should the nurse take first?

a)

Administer the prescribed acetaminophen

b)

Encourage the patient to use the incentive spirometer

c)

Notify the healthcare provider

d)

Obtain a wound culture

2.

The nurse is caring for a patient with hypothermia. After initiating rewarming with warm IV fluids and blankets, the patient’s heart rate drops to 42 bpm. What is the nurse’s priority action?

a)

Continue rewarming and recheck heart rate in 15 minutes

b)

Administer a prescribed antiarrhythmic

c)

Stop active rewarming and assess cardiac rhythm

d)

Apply oxygen via nasal cannula

3.

A 78-year-old patient is admitted after being found in a cold house. The nurse notes a temperature of 94°F (34.4°C) and a heart rate of 48 bpm. Which intervention should be included in the plan of care?

a)

Apply a heating pad to the patient’s chest

b)

Begin rewarming with warm blankets and warm IV fluids

c)

Encourage the patient to drink warm tea

d)

Place the patient in a hot bath for rapid rewarming

4.

The nurse identifies patients at risk for developing hypothermia. Which clients are at highest risk? (Select all that apply.)

a)

A 3-day-old infant

b)

A 78-year-old with hypothyroidism

c)

A middle-aged marathon runner

d)

A patient with a spinal cord injury

e)

A 45-year-old construction worker working outdoors in winter

5.

The nurse is teaching a patient about preventing hyperthermia during summer activities. Which statement indicates the need for further teaching?

a)

“I’ll take frequent breaks in shaded areas when it’s hot.”

b)

“I’ll drink plenty of fluids before and during outdoor activity.”

c)

“I’ll wear lightweight, light-colored clothing.”

d)

“I’ll take salt tablets before I exercise to replace what I lose when sweating.”

6.

A nurse is caring for an older adult patient admitted with confusion, cold skin, and a core temperature of 95°F (35°C). Which nursing diagnosis is most appropriate?

a)

Ineffective thermoregulation related to environmental exposure

b)

Risk for infection related to decreased immunity

c)

Ineffective breathing pattern related to hypoventilation

d)

Deficient fluid volume related to inadequate intake

7.

A patient presents to the emergency department after working outside in 102°F weather. The patient is flushed, hot, and confused with dry skin. What is the priority nursing action?

a)

Obtain an order for acetaminophen

b)

Move the patient to a cool environment and start IV fluids

c)

Apply warm blankets to prevent chills

d)

Provide oral fluids and recheck temperature in one hour

8.

The nurse reinforces teaching about applying heat and cold therapy. Which statements by the patient indicate correct understanding? (Select all that apply.)

a)

“I’ll use a towel between my skin and the heating pad.”

b)

“I’ll check the skin often for redness or numbness.”

c)

“I’ll apply heat for at least an hour so it penetrates deeply.”

d)

“I’ll use cold therapy for 15–20 minutes at a time.”

e)

“I’ll avoid using heat over areas of poor circulation.”

9.

The nurse is caring for a patient with a fever of 102.4°F (39.1°C). Which nursing action best promotes comfort and heat loss?

a)

Lower the room temperature and apply a light blanket

b)

Increase room temperature to promote sweating

c)

Provide a warm bath to induce vasodilation

d)

Restrict fluids to prevent fluid overload

10.

A nurse is evaluating a patient being treated for hypothermia. Which finding indicates that treatment has been effective?

a)

The patient’s skin remains cool and pale

b)

The patient’s heart rate decreases from 72 to 50 bpm

c)

The patient’s temperature increases gradually to 98°F (36.6°C)

d)

The patient develops shivering and mild confusion