Alaine88

1. The nurse knows that which statement by the mother indicates that the mother understands safety precautions with her four month-old infant and her 4 year-old child? A) "I strap the infant car seat on the front seat to face backwards." B) "I place my infant in the middle of the living room floor on a blanket to play with my 4 year old while I make supper in the kitchen." C) "My sleeping baby lies so cute in the crib with the little buttocks stuck up in the air while the four year ol...

Digoxin levels need to be monitored closely when the following medication is started: 1 . Loratadine 2 . Diphenhydramine 3 . Ipratropium 4 . Albuterol Albuterol 2. Patients with pheochromocytoma should avoid which of the following classes of drugs because of the possibility of developing hypertensive crisis? 1 . Expectorants 2 . Beta-2-agonists 3 . Antitussives 4 . Antihistamines Beta 2-agonists 3. Stan, a 42-year-old African American, has moderate persistent as...

1. During a mental status examination, the nurse wants to assess a patient’s affect. The nurse should ask the patient which question? “How do you feel today?” 2. The nurse is planning to assess new memory with a patient. The best way for the nurse to do this would be to: Give him the Four Unrelated Words Test. 3. A 45-year-old woman is at the clinic for a mental status assessment. In giving her the Four Unrelated Words Test, the nurse would be concerned if she could not four unrela...

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...

1) A nurse is caring for a client who is breastfeeding and states that her nipples are sore. Which of the following interventions should the nurse suggest? a) apply mineral oil to the nipples between feedings b) keep the nipples covered between breastfeeding sessions c) change the newborn’s position on the nipples with each feeding d) increase the length of time between feedings 2) A nurse is caring for a client who is 4 hr postpartum following a vaginal birth. The client has saturated ka...

1. A nurse is performing a vaginal exam on a client who is in active labor. The nurse notes the umbilical cord protruding through the cervix. Which of the following actions should the nurse take? Administer oxytocin to the client via intravenous infusion. Apply oxygen at 2 L/min via nasal cannula. Prepare for insertion of an intrauterine pressure catheter. Assist the client into the knee-chest position. 2. A nurse is assessing a newborn who is 48 hr old and is experiencing opioid withdrawals....

A nurse is caring for a client who is 2 weeks postpartum following a cesarean birth. Which of the following clinical findings should the nurse identify as an indication of postpartum infection? a. Unilateral breast pain i. Mastitis - painful or tender localized hard mass and reddened area, usually on one breast. (Pg. 143) b. Persistent abdominal striae i. Stretch marks - expected finding c. Lochia alba i. Lasts approx day 11 up to 4-8 weeks post-birth d. WBC count 12,000/mm3 2. A nurse...

A nurse is caring for a client who is 2 weeks postpartum following a cesarean birth. Which of the following clinical findings should the nurse identify as an indication of postpartum infection? a. Unilateral breast pain i. Mastitis - painful or tender localized hard mass and reddened area, usually on one breast. (Pg. 143) b. Persistent abdominal striae i. Stretch marks - expected finding c. Lochia alba i. Lasts approx day 11 up to 4-8 weeks post-birth d. WBC count 12,000/mm3 2. A nurse...

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 15 years old high school student with a mild sore throat and low-grade fever that has persisted for about 3 weeks. She reports general malaise, fatigue, and loss of appetite. The NP suspects mononucleosis. Which of the following is the LEAST appropriate intervention? a. Palpate the lymph nodes and spleen b. Examine the posterior oropharynx for petechiae c. Obtain a CBC, throat culture, and heterophil antibody test. d. Obtain an urinalyses and serum for LFTs and amylase Explanation: mo...

1. A nurse is assessing a client who had a recent stroke. Which of the following findings should indicate to the nurse the need for referral to an occupational therapist? a. Facial drooping b. Receptive aphasia c. Unilateral neglect d. Memory loss 2. A charge nurse in the newborn nursery is delegating tasks to an assistive personnel (AP). Which of the following is an appropriate task for the AP? a. Show a new mother how to change the newborn’s diaper b. Inspect the skin of a newbo...

A nurse is caring for a client who is hospitalized and has expressive aphasia. The client's family reports that the nurse failed to obtain written informed consent before inserting an indwelling urinary catheter. Which of the following responses should the nurse make? "Procedures prescribed by the provider do not require consent." "This is a procedure that does not require written informed consent." • "You are right. I will discuss this issue with the charge nurse." "Would you mind s...

QUESTIONS,ANSWERS AND RATIONALES. 1. A nurse is assessing pressure ulcers on four clients to evaluate the effectiveness of a change in the wound care procedure. Which of the following findings indicate wound healing. a. Erythema on the skin surrounding a client's wound b. Deep red color on the center of the clients wound c. Inflammation noted on the tissue edges of a client's wound d. Increase in serosanguineous exudate from the clients wound (damaged capillaries) Rationale: Leadership...

1. A nurse is teaching a client and his family how to care for the client’s tracheostomy at home. Which of the following should the nurse include in the teaching? a. Use tracheostomy covers when outdoors 2. A home health nurse is performing a follow-up visit for a client who has a gastrostomy tube through which they receive intermittent feedings and medications. The client has recently developed diarrhea. Which of the following findings should the nurse identify as a possible cause of the di...

1. The order is to give 60 mg of Garamycin (gentamicin) IM every 8hr. The vial is labeled 80 mg/ 2 mL. How many mL will you give? ? mL = 2mL/80 mg X 60 mg/(1) = 12/8 = 1.5 mL 2. The patient is to receive 65 Units of a drug. The vial is labeled 50 Units per 2 mL. How many mL will you give? ? mL = 2 mL/50 units X 65 units/(1) = 130/50 = 2.6 mL 3. The patient is to receive 0.6 g of a drug. How many mg will you give? ? mg = 1000 mg/1 g X 0.6 g/(1) = 600/1 = 600 mg 4. The patient ...

A nurse is planning care for a newborn who has hyperbilirubinemia and is to receive phototherapy. Which of the following interventions should the nurse include? Place the newborn 45 cm (18 in) from the light source 2 an assistive personnel tells the nurse that several client measurements were obtained with morning vital signs. Which of the following clients should the nurse plan to assess? Head injury HR 60 5 A community health nurse recognizes that the teen pregnancy rate in the community ha...

1. The nurse cares for a client diagnosed with superficial partial thickness burn. The nurse should assign the client to a room with which client? A. A client diagnosed with Cushing’s Syndrome. B. A client Diagnosed with cellulitis of the left leg. C. A Client diagnosed with acute peritonsillar abscess. D. A client diagnosed with acute pelvic inflammatory disease. Answer: A 2. The nurse observes client care on a geriatric unit. The nurse should intervene in which situation? a. A studen...

1. A nurse is reaching a client and his family how to care for the client’s tracheostomy at home. Which of the following should the nurse include in the teaching? a. Use tracheostomy covers when outdoors 2. A home health nurse is performing a follow-up visit for a client who has a gastrostomy tube through which they receive intermittent feedings and medications. The client has recently developed diarrhea. Which of the following findings should the nurse identify as a possible cause of the di...

1. The order is to give 60 mg of Garamycin (gentamicin) IM every 8hr. The vial is labeled 80 mg/ 2 mL. How many mL will you give? ? mL = 2mL/80 mg X 60 mg/(1) = 12/8 = 1.5 mL 2. The patient is to receive 65 Units of a drug. The vial is labeled 50 Units per 2 mL. How many mL will you give? ? mL = 2 mL/50 units X 65 units/(1) = 130/50 = 2.6 mL 3. The patient is to receive 0.6 g of a drug. How many mg will you give? ? mg = 1000 mg/1 g X 0.6 g/(1) = 600/1 = 600 mg 4. The patient ...