The elder is admitted to the hospital with complaints of left-sided
weakness & difficulty speaking. Which of the following assessments
contains the data that nest represents a nursing assessment?
(Ans –
Elder is unable to communicate basic needs & cannot perform hygiene
measures with left hand.
Which of the following pt data would be considered subjective data (all
that apply).
(Ans –
-A pt describes his pain as an 8 on the pain assessment scale.
-A pt feels nauseated after eating his bf.
-A pt complains of being cold & requests an extra blanket.
(subjective=What the pt states)
(objective=What you see)
A client has been instructed on the use of an incentive spirometer. The
RN evaluates that the client understood the instruction if the client
performs which of the following actions?
, (Ans - Exhales completely, places mouth around mouthpiece before
inhaling slowly to reach the indicator, removes mouthpiece, holds
breath, and exhales slowly.
A client is being d/c with O2 therapy via Nasal cannula. Which of the
following instructions should the nurse give to the client & family?
(Ans - Wear cotton clothing to avoid static electricity.
A client is on a full liquid diet following gastric surgery. The RN evaluates
the health teaching to be successful when the family bring in which of
the following for the client to eat?
(Ans - Custard
RN on the unit observes that the NOC shift RN has placed restraints on
all of the following clients. In which situations(s) would the nurse
conclude that the use of restrains is appropriate? ( all that apply).
(Ans –
-Infant that has just had a cleft palate repair & is trying to suck his
thumb.
-Young client who is cognitively impaired & fell 3 times even with a bed
alarm on.