The nurse is presenting an educational session on safety for parents of adolescents.
Which information will the nurse include in the teaching session?
a. Increased aggressiveness and blood spots on clothing may indicate substance abuse.
b. Increased aggressiveness is an environmental clue that may indicate an adolescent is
abusing.
c. Adolescents need information about the effects of uncoordination on accidents.
d. Adolescents need to be reminded to use seat belts primarily on long trips.
ANS: A
Increased aggressiveness (psychosocial clue) and blood spots on clothing
(environmental
clue) may indicate substance abuse. School-age children are often
uncoordinated. Seat belts
should be used all the time. In fact, teens have the lowest rate of seat belt use.
,A nurse reviews the history of a newly admitted patient. Which finding will alert the
nurse that the patient is at risk for falls?
a. 55 years old
b. 20 /20 vision
c. Urinary continence
d. Orthostatic hypotension
ANS: D
Numerous factors increase the risk of falls, including a history of falling, being
age 65 or over,
reduced vision, orthostatic hypotension, lower extremity weakness, gait and
balance
problems, urinary incontinence, improper use of walking aids, and the effects
of various
medications (e.g., anticonvulsants, hypnotics, sedatives, certain analgesics).
The patient has been diagnosed with a respiratory illness and reports shortness of
breath.
The nurse adjusts the temperature to facilitate the comfort of the patient. At which
temperature range will the nurse set the thermostat?
a. 60 ° to 64° F
b. 65 ° to 75° F
c. 15 ° to 17° C
d. 25 ° to 28° C
ANS: B
A person's comfort zone is usually between 18.3° and 23.9° C (65° and 75° F).
The other
, ranges are too low or too high and do not reflect the average person's
comfort zone
The patient applies sequential compression devices after going to the bathroom. The
nurse
checks the patient's application of the devices and finds that they have been put on
upside
down. Which nursing diagnosis will the nurse add to the patient's plan of care?
a. Risk for falls
b. Deficient knowledge
c. Risk for suffocation
d. Impaired physical mobility
ANS: B
The patient has a knowledge need and requires instruction regarding the
device and its
purpose and procedure. The nurse will intervene by teaching the patient
about the
sequential compression device and instructing the patient to call for
assistance when getÝng
up to go to the bathroom in the future, so that the nurse may assist with
removal and proper
reapplication. No data support a risk for falls, impaired physical mobility, or
suffocation.
The nurse is discussing about threats to adult safety with a college group. Which
statement by a group member indicates understanding of the topic?
a. "Smoking even at parties is not good for my body."
b. "Our campus is safe; we leave our dorms unlocked all the time."
Which information will the nurse include in the teaching session?
a. Increased aggressiveness and blood spots on clothing may indicate substance abuse.
b. Increased aggressiveness is an environmental clue that may indicate an adolescent is
abusing.
c. Adolescents need information about the effects of uncoordination on accidents.
d. Adolescents need to be reminded to use seat belts primarily on long trips.
ANS: A
Increased aggressiveness (psychosocial clue) and blood spots on clothing
(environmental
clue) may indicate substance abuse. School-age children are often
uncoordinated. Seat belts
should be used all the time. In fact, teens have the lowest rate of seat belt use.
,A nurse reviews the history of a newly admitted patient. Which finding will alert the
nurse that the patient is at risk for falls?
a. 55 years old
b. 20 /20 vision
c. Urinary continence
d. Orthostatic hypotension
ANS: D
Numerous factors increase the risk of falls, including a history of falling, being
age 65 or over,
reduced vision, orthostatic hypotension, lower extremity weakness, gait and
balance
problems, urinary incontinence, improper use of walking aids, and the effects
of various
medications (e.g., anticonvulsants, hypnotics, sedatives, certain analgesics).
The patient has been diagnosed with a respiratory illness and reports shortness of
breath.
The nurse adjusts the temperature to facilitate the comfort of the patient. At which
temperature range will the nurse set the thermostat?
a. 60 ° to 64° F
b. 65 ° to 75° F
c. 15 ° to 17° C
d. 25 ° to 28° C
ANS: B
A person's comfort zone is usually between 18.3° and 23.9° C (65° and 75° F).
The other
, ranges are too low or too high and do not reflect the average person's
comfort zone
The patient applies sequential compression devices after going to the bathroom. The
nurse
checks the patient's application of the devices and finds that they have been put on
upside
down. Which nursing diagnosis will the nurse add to the patient's plan of care?
a. Risk for falls
b. Deficient knowledge
c. Risk for suffocation
d. Impaired physical mobility
ANS: B
The patient has a knowledge need and requires instruction regarding the
device and its
purpose and procedure. The nurse will intervene by teaching the patient
about the
sequential compression device and instructing the patient to call for
assistance when getÝng
up to go to the bathroom in the future, so that the nurse may assist with
removal and proper
reapplication. No data support a risk for falls, impaired physical mobility, or
suffocation.
The nurse is discussing about threats to adult safety with a college group. Which
statement by a group member indicates understanding of the topic?
a. "Smoking even at parties is not good for my body."
b. "Our campus is safe; we leave our dorms unlocked all the time."
