“I look forward to returning to my local health club to swim.” “The local ostomy support group meets on Wednesday morning at 10 a.m.” “My stoma should be cleaned daily with soap and water.” “During the day I will wear a leg bag to collect my urine.”
A client is having a tonic-clonic seizure. Which of the following should the nurse do first ?
call for assistance restrain the client turn the client on her side provide a safe environment
A nurse is following the progress of a client being treated for hypothyroidism. Which findings indicate the client is experiencing side effects of the thyroid replacement therapy? Select all that apply.
excessive sweating constipation inability to tolerate cold leg cramps
A nurse is preparing discharge instructions for a client with a below-the-knee amputation. Which instruction would be a priority ?
sterile wound management elevation of residual limb performing prescribed exercises reporting occurrence of phantom limb pain immediately
While preparing a client for a colonoscopy, the nurse would be correct to implement which interventions? Select all that apply.
instruction on high fiber diet the day before the procedure instruction that a sedative will be administered before the procedure instruction not to eat or drink 6 – 12 hours before the procedure instruction not to eat or drink 18 hours before the procedure
A nurse is caring for a client, diagnosed with Parkinson’s disease, who scored as a high-risk fall candidate on the St. Thomas Risk Assessment Tool in Falling Elderly Inpatients. Which nursing interventions should the nurse implement? Select all that apply.
provide the client with a call-light device keep the bed in the lowest position use a beveled floor mat at bedside implement a bed alarm
A nurse is monitoring a client’s intracranial pressure (ICP) after a motor vehicle accident. Upon checking the ICP, the nurse knows to contact the physician. What reading would warrant this action?
8 mm Hg 14 mm Hg 18 mm Hg 22 mm Hg
A client is admitted to the ED after complaining of acute chest pain radiating down the left arm. The client is diaphoretic and anxious, and has difficulty breathing. Which laboratory studies would the nurse anticipate?
blood urea nitrogen (BUN) white blood cell count LDH myoglobin
An elderly man is admitted to the ED during the night shift. He reports slipping and hitting his forehead on the bathtub several hours earlier. The nurse is assessing the client’s frontal lobe function. Which of the following questions/statements should the nurse ask the client?
“Tell me when you feel me touch your arm.” “Tell me when you stop hearing the tuning fork sound.” “Do you have problems with balance?” “How much is two plus four plus seven?”
The nurse is assessing a client with Addison’s disease. The nurse expects to note which of the following?
craving of salty foods weight gain craving of sweet foods hyperactivity