Alaine88

LOC • Alert: responsive, answer questions appropriately, opens eyes spontaneously. • Lethargic: open their eyes, can answer questions but easily falls asleep. • Stupor: barely responds to painful stimuli (like rubbing the patients’ sternum) • Comatose: unconscious/does not respond to painful stimuli • Decorticate: flexion/ internal rotation of upper extremities, joints and legs • Decerebrate: neck/elbows extension, wrist and finger flexion Torts: unintentional torts- negli...

1.A nurse is assessing a client who is 12hr postoperative following a colon resection. Which of the following findings should the nurse report to the surgeon? 1. Heart rate 90/min 2. Absent bowel sounds → normal findings after major bowel surgery; takes several days to return to normal. 3. Hgb 8.2 g/dl 4. Gastric pH of 3.0 Rationale: Normal Hgb is 13-18M g/dl, 12-16 g/dl. This may indicate a possible hemorrhaging. 2. A nurse is caring for a client who has diabetes insipidus. Which of t...

1. A nurse is reinforcing teaching with a client who has HIV and is being discharged to home. Which of the following instructions should the nurse include in the teaching? 1) Take temperature once a day. 2) Wash the armpits and genitals with a gentle cleanser daily. 3) Change the litter boxes while wearing gloves. 4) Wash dishes in warm water. 2. A nurse is caring for a client who is postoperative following a tracheostomy, and has copious and tenacious secretions. Which of the following is ...

1. Which nursing diagnosis has the highest priority for a postpartum client who has developed disseminated intravascular coagulopathy (DIC) A. Anticipating Grieving B. High risk for infection C. Risk for deficient fluid volume D. Spiritual Distress 2. A newly delivered 9lb 4 ounce baby boy exhibits of respiratory distress. The nurse obtains a blood sample to assess the infant for which of the following? A. Hypoglycemia B. Pneumonia C. Sepsis D. Hyperbilirubinemia 3. The nurse explain...

Intrapersonal communication is the communication within an individual. It is each person’s “self-talk,” the internal discussion when thinking but not outwardly verbalizing thoughts. Interpersonal communication is communication between two people. This form of communication is the most common in nursing and requires an exchange of information with another individual. Public communication is communication within groups of people. Transpersonal communication is communication that addresses s...

A nurse is assisting with the selection of clients to discharge to make beds available following a tornado in the community. Which of the following clients should the nurse recommend for discharge? • A client who is recovering from a laparoscopic appendectomy that was performed 24 hr ago RATIONALE: A client who had an appendectomy without complications is often discharged the day of or the day after surgery. The nurse should recommend this client for discharge because this client has a lo...

1) A nurse is teaching a client who has schizophrenia about her new prescription for risperidone. Which of the following statements should the nurse include in the teaching? a. “You should continue this medication if you develop muscle rigidity”. b. “You will experience weight loss while taking this medication.” c. “You will notice your symptoms improve within 24 hours of taking this medication.” d. “You should increase your consumption of complex carbohydrates.” 2) A nurse ...

1. A nurse in a rural community center is providing education to a group of clients about first aid interventions for snake bites to prevent further injury. Which of the following instruction should the nurse include in the teaching? a. Apply an ice pack directly to the affected area b. Immobilize the affected extremity with a splint c. Place tourniquet above and below the affected area d. Elevate the affected extremity 2. A nurse in an Emergency Department is caring for a client who sustain...

1. A Nurse is contributing to the plan care of a care to promote a restful night’s sleep for a client who has Alzheimer’s disease. Which of the following interventions should the nurse include in the plan? Encourage stimulating activities after dinner Encourage a late afternoon nap Offer a small snack at bedtime Offer hot chocolate at bedtime 2. A nurse if reinforcing teaching with a client who has chronic kidney disease about disease management. Which of the following statements by t...