Which assessment is most important for the nurse to perform on a client
f f f f f f f f f f f f
f who is hospitalized for Guillain-Barre syndrome that is rapidly
f f f f f f f f
f progressing?
Respiratory effort. f
Unsteady gait. f
Intensity of pain. f f
Ability to eat. f f
Guillain-Barre syndrome causes paralysis or weakness that typically starts
f f f f f f f f
at the feet and progresses upwards. As the condition progresses, the nurse
f f f f f f f f f f f
f must ensure that the client is able to breathe effectively.
f f f f f f f f f
Heuther, Understanding Pathophysiology, 6th ed. p. 412
f f f f f f
A male client comes into the clinic with a history of penile discharge
f f f f f f f f f f f f
f with painful, burning urination. Which action should the nurse
f f f f f f f f
implement?
• Collect a culture of the penile discharge.
f f f f f f
• Palpate the inguinal lymph nodes gently.
f f f f f
,Page 2 of 103
• Observe for scrotal swelling and redness.
f f f f f
,Page 3 of 103
• Express the discharge to determine color.
f f f f f
, Page 4 of 103
Penile discharge with painful urination is commonly associated with
f f f f f f f f
f gonorrhea. The nurse should collect a culture of the penile discharge to
f f f f f f f f f f f
f determine the cause of these symptoms. The cause must be determined or
f f f f f f f f f f f
f confirmed through culture to identify the organism and ensure effective
f f f f f f f f f
f treatment.
Jarvis Physical Examination and Health Assessment, 6th
f f f f f f
f edition 3 f
A client with history of atrial fibrillation is admitted to the telemetry unit
f f f f f f f f f f f f
f with suddenf
onset of shortness of breath. The nurse observes a new irregular heart
f f f f f f f f f f f
f rhythm and should perform which assessment at this time?
f f f f f f f f
• Check for a pulse deficit. f f f f
• Palpate the apical impulse. f f f
• Inspect jugular vein pulse. f f f
• Examine for a carotid bruit. f f f f
A client with a past history of atrial fibrillation may return to that
f f f f f f f f f f f f
f rhythm. Any signs of atrial fibrillation, such as sudden onset shortness
f f f f f f f f f f
f of breath, requires further investigation. The nurse should assess this
f f f f f f f f f
f client for a pulse deficit because this condition occurs with atrial
f f f f f f f f f f
f fibrillation.
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Ascorers. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $16.49. You're not tied to anything after your purchase.