Samenvattingen, Aantekeningen en Examens

Right sided heart failure Correct Answer - Distended abdomen Jugular vein neck distention Dependent edema Left sided heart failure Correct Answer - Oliguria during the day (b/c decreased blood flow to kidneys) Fluid Volume Overload assessment findings Correct Answer - Distended neck veins Dehydration assessment findings Correct Answer - Tenting Orthostatic hypotension Positive response to HIV treatment Correct Answer - Decreased viral load Stage II Lyme disease Correct Answer -...

A nurse is caring for a client who has a new diagnosis of type 2 diabetes mellitus and reports difficulty following the diet and remembering to take the prescribed medication. Which of the following actions should the nurse take to promote client compliance? SATA A. Ask the dietitian to assist with meal planning. B. Contact the clients support system. C. Assess for age-related cognitive awareness. D. Provide educational materials for home use. Correct Answer - A, B, D, E A nurse in healt...

A nurse is planning care for a client who has a full-thickness burns on the lower extremities. Which of the following interventions should the nurse include? a) Limit visitation time for client's children to 40 minutes per day b) clean the equipment in the client's room once per week c) provide a diet of fresh fruits and vegetable for the client d) apply new gloves when alternating between wound care sites Correct Answer - d) apply new gloves when alternating between wound care sites ...

A nurse is admitting a client who has a suspected MI and a history of angina. Which of the following findings will help the nurse distinguish angina from an MI? A. Angina can be relieved with rest and nitroglycerin B. The pain of an MI resolves in less than 15 minutes C. The type of activity that causes an MI can be identified D. Angina can occur for longer than 30 minutes. Correct Answer - A. Angina can be relieved with rest and nitroglycerin A nurse on a cardiac unit is reviewing the la...

A nurse is planning care for a client who is receiving mechanical ventilation. Which of the following actions should the nurse include in the plan A. Provide the client with a means of communication B. Maintain the head of the client's bed in a flat position C. Suction the client's endotracheal tube every 4 hr D. Perform oral hygiene for the client every 8 hr Correct Answer - A Use electronic tablet computer, programmable speech generating device, alphabet board, pencil and paper, etc ...

A nurse is caring for a client who is postoperative following vein ligation and stripping for varicose veins. Which of the following actions should the nurse take? a) position the client supine with his legs elevated when in bed b) encourage the client to ambulate for 15 minutes every hour while awake for the first 24 hr c) the client to sit with his legs dependent after ambulating d) instruct the client to wear knee-length socks for 2 weeks after surgery Correct Answer - a) position the c...

A nurse is providing teaching to a client who has stage II cervical cancer and is scheduled for brachytherapy. Which of the following instructions should the nurse include? "You will have an implant placed twice each month for the duration of the treatment." "You should remain at least 6 feet away from others between treatments." "You should expect to have blood in your urine for a few days after treatment." "You will need to stay still in the bed during each treatment session." Co...

A nurse is caring for a client who is to have his chest tube removed. Which of the following actions should the nurse take? A. Cover the insertion site with a hydrocolloid dressing after removal B. Provide pain medication immediately after removal C. Instruct the client to perform the Valsalva maneuver during removal D. Delegate removal of the chest tube to a LPN Correct Answer - C The nurse should instruct the patient to perform the Valsalva maneuver during removal to maintain the appropr...

a nurse is assessing a pt who has a history of migraine headaches with aura and reports feeling a "migraine coming on", the nurse should expect the pt to report what manifestation Correct Answer - visual disturbance a nurse is teaching a pt who has a new diagnosis of MS about visual changes she might experience as the disease progresses, what would she include? Correct Answer - double vision a nurse is teaching a pt who has asthma about using a peak flow meter, when a yellow zone meter r...

A nurse in an emergency department is preparing to perform an ocular irrigation for a client. Which of the following actions should the nurse plan to take? a. Assess the client's visual acuity prior to irrigation b. Have the client turn their head toward the unaffected eye c. Hold the irrigator syringe 3.81 cm (1.5 in) above the eye d. Perform the irrigation with sterile water for irrigation Correct Answer - d. Perform the irrigation with sterile water for irrigation A nurse is preparing...