- Study guides, Class notes & Summaries

A newly admitted client complains of pain rating a 7 on a scale of 0 to 10. The client has not been sleeping well lately and is experiencing labored breathing. List the client's problems in order of priority for the nurse. (Rank in the priority order from highest to lowest.) 1. Airway and breathing. 2. Pain management. 3. Definitive therapy. 4. Sleep and rest.Correct Answer: 1.Airway and breathing. 2.Pain management. 3.Sleep and rest. 4.Definitive therapy. Rationale First-level pro...

Following discharge teaching, a male client with duodenal ulcer tells the nurse the he will drink plenty of dairy products, such as milk, to help coat and protect his ulcer. What is the best follow-up action by the nurse?Review with the client the need to avoid foods that are rich in milk and cream A male client with hypertension, who received new antihypertensive prescriptions at his last visit returns to the clinic two weeks later to evaluate his blood pressure (BP). His BP is 158/106 and h...

The nurse has completed giving discharge instructions to a client who has had a total joint replacement (TJR) of the knee with a metal prosthetic system. The nurse determines that the client understands the instructions if the client makes which statement? 1."Changes in the shape of the knee are expected." 2."Fever, redness, and increased pain are expected." 3."All caregivers should be told about the metal implant." 4."Bleeding gums or black stools may occur, but this is normal."...

A nurse who has recently completed orientation is beginning work in the labor and delivery unit for the first time. When making assignments, which client should the charge nurse assign to this new nurse? A multiparous client who is dilated 5 cm and 50% effaced A client with human immunodeficiency virus (HIV) infection has white lesions in the oral cavity that resemble milk curds. Nystatin (Mycostatin) preparation is prescribed as a swish and swallow. Which information is most important for th...

A client is receiving a continuous half strength tube feeding at 50ml/hour. To prepare enough of the solution for eight hours, how many ml of full strength feeding will the nurse need? (Enter numeric value only.) 200ml . 25 ml of full strength feeding mixed with 25ml of water provided 50ml of half strength. 25ml × 8 hours= 200ml An elderly male client is experiencing urinary incontinence. What is the best initial nursing action? Apply an external condom catheter 3. A male Muslim client wi...

1. The nurse is caring for a pre-adolescent client in skeletal Dunlop traction. Which nursing intervention is appropriate for this child? A) Make certain the child is maintained in correct body alignment. B) Be sure the traction weights touch the end of the bed. C) Adjust the head and foot of the bed for the child's comfort D) Release the traction for 15-20 minutes every 6 hours PRN. A: Make certain the child is maintained in correct body alignment. 2. The nurse is assessing a health...

The nurse is providing teaching to a client with type 2 diabetes mellitus about important points for disease and symptom management. Which statement by the client indicates understanding? A Using salt, herbs, and spices will improve the flavor of foods. B Get an eye examination with an ophthalmologist annually. C Arrange diet schedule around three regular meals a day. D Inspect feet every month for ingrown nails, cuts, and calluses. B Get an eye examination with an ophthalmologist annually...

The nurse is has just admitted a client with severe depression. From which focus should the nurse identify a priority nursing diagnosis? A) Nutrition B) Elimination C) Activity D) Safety D: Safety While explaining an illness to a 10 year-old, what should the nurse keep in mind about the cognitive development at this age? A) They are able to make simple association of ideas B) They are able to think logically in organizing facts C) Interpretation of events originate from their own persp...

A pt presses the call bell and requests pain medication for a severe headache. To assess the quality of the pt. Pain, which approach should the nurse use? Ask the patient to describe the pain The nurse is wearing personal protective equipment while caring for a pt. When exiting the room, which PPE should be removed first? Gloves An older pt is brought to the ED with a sudden onset of confusion that occurred after experiencing a fall at home. The daughter, who has power of attorney, has bro...

Male client admitted the morning of scheduled surgery told nurse he drank water last night amount of water and what time was taken why would nurse apply pressure to lacrimal duct after optic meds reduce systemic effects comatose patient mouth care side lying position morning care client have seizure protect pt head charge nurse assign pn insulin injections 2 doses missing complete report pt on suicide ask about discharge increases suicide precautions photo of chest and locat...