John Tyler Community College

You are a pediatric nurse who is receiving a change-of-shift report. The previous nurse reports that your team has taken two overflow patients from another unit. Based on the following information, prioritize your four patients and explain your rationale. a) A 4-year-old with ASD who is withdrawn with staff b) An 8-year-old who has ADHD who has not eaten much throughout the day due to inattention c) A 50-year-old post-op patient with possible delirium who was hyperactive during the day and ...

sentinel events - Answer - any unanticipated event in a healthcare setting resulting in death or serious physical or psychological injury to a patient or patients, not related to the natural course of the patient's illness patient medical record - Answer - medical record is used for legal documentation as well as for communication among health team members, care panning, quality assurance, financial reimbursement by insurers, education, and research - nursing admission assessment ...

A nurse is assessing a client who has a new diagnosis of systemic lupus erythematosus (SLE). The nurse should identify which of the following as a cutaneous manifestation of SLE? -Facial pallor -muscle atrophy -foot ulcers -butterfly rash on face - Answer butterfly rash on face A nurse is teaching a female client who has a new diagnosis of systemic lupus erythematosus (SLE). The nurse should recognize the need for further teaching when the client identifies which of the following as ...

Crohn's disease can be described as a chronic relapsing disease. Which of the following areas in the GI system may be involved with this disease? A. The entire length of the large colon B. Only the sigmoid area C. The entire large colon through the layers of mucosa and submucosa D. The small intestine and colon; affecting the entire thickness of the bowel - Answer D. The small intestine and colon; affecting the entire thickness of the bowel Crohn's disease can involve any segment...

ethical principles - Answer autonomy beneficence nonmaleficence confidentiality fidelity justice veracity things you can NOT delegate - Answer shift assessment/eval medicine administration nursing process - Answer assess diagnose plan implement evaluate types of nursing assessments - Answer emergency focused comp

mild anxiety - Answer sharp senses, increased motivation, heightened awareness, enhanced learning, optimal functioning; can reach patient to calm them down moderate anxiety - Answer narrowed perceptional field, less alert, decreased concentration, decreased problem solving, muscular tension, restlessness; can reach patient to calm them down severe anxiety - Answer concentration progressively narrowed, severe impairment of attention, severe cognitive impairment, physical and emotio...

A nurse is caring for a client who has bipolar disorder and a new prescription for valproate. Which of the following instructions should the nurse give the client about the use of the medication? A) thyroid function tests should be performed every 6 mths B) liver function tests must be monitored C) high serum sodium levels can cause toxic levels of valproate D) a pretreatment electroencephalogram (EEG) will be done - Answer B) pancreatitis, hepatic dysfunction, and thrombocytopenia are a...

The nurse assesses a patient's surgical wound on the first postoperative day and notes redness and warmth around the incision. Which action by the nurse is appropriate? a. Obtain wound cultures. b. Notify the health care provider. c. Document the assessment. d. Assess the wound every 2 hours. - Answer ANS: C The incisional redness and warmth are indicators of the normal initial (inflammatory) stage of wound healing by primary intention. The nurse should document the wound appearan...

The nurse is providing health promotion teaching to a group of older adults. Which information will the nurse include when teaching about routine glaucoma testing? a. A Tono-Pen will be applied to the surface of the eye. b. The test involves reading a Snellen chart from 20 feet. c. Medications will be used to dilate the pupils for the test. d. The examination involves checking the pupil's reaction to light - Answer a. A Tono-Pen will be applied to the surface of the eye Glaucoma is ...

NSG 170 -Fluid and Electrolytes Exam Questions With Complete Solutions