decreased appetite urinary tract infection orthostatic hypotension muscular atrophy and foot drop boredom, frustration, and anxiety increased length of hospitalization
The clinic nurse is seeing a pregnant client who is expecting her first child. She complains of morning sickness and nasal stuffiness. The nurse recommends interventions to minimize discomfort from her symptoms. Which should the nurse recommend? Select all that apply.
take ginger pills to alleviate nausea drink a full glass of water at each meal use a humidifier to help with congestion eat dry crackers before getting out of bed in the morning eat three regular meals each day to provide needed nutrients use an over-the-counter nasal spray such as a saline-based spray
5The nurse is caring for a client who is sedated and on the ventilator in ICU. The family expresses concern about controlling the client’s pain when he cannot speak. The nurse explains that assessing pain in a nonverbal client involves watching for which of the following signs? Select all that apply.
grabbing at the bed rails biting the ventilator tubing facial grimacing stiffness or rigidity of the body decreased urinary output increased blood pressure and heart rate as shown on the cardiac monitor
The nurse is caring for a client with sternal wires following a coronary artery bypass graft (CABG). The client complains of severe pain when coughing and deep breathing. What nonpharmacological measures can the nurse take to increase client comfort? Select all that apply.
apply hot packs to the sternum give morphine PRN for pain before client coughs suggest using audio books or relaxing music as a distraction teach the client how to use a pillow to splint the chest when coughing encourage the client to engage in prayer, meditation, or other activities properly position the head of the…
The nurse is teaching a client diagnosed with gastroesophageal reflux disease (GERD) about dietary measures to manage symptoms. Which food does the nurse advise the client to avoid?
bananas tomatoes white bread grilled salmon steel-cut oatmeal
The nurse is caring for a comatose client with a Salem sump tube. Which action by the nurse is correct regarding care of this client?
clamp the air vent during tube feedings place the client on the left side in a high-Fowler’s position assess the position of the Salem sump before each feeding infuse bolus feedings with a pump or by gently plunging into the stomach
The nurse is teaching infant CPR to a group of newly graduated nurses hired to work in the labor and delivery unit. The nurse understands that proper technique with infants includes which action? Select all that apply.
The femoral artery is checked for a pulse following each cycle of CPR. Chest compression depth should be approximately 1.5 inches, or 4 cm. A single rescuer should use three fingers on the dominant hand to do compressions. Rest the infant facedown on the forearm with the hand supporting the head and jaw. If arrest…
The nurse is caring for a client with COPD who complains of poor quality of sleep. Which question should the nurse ask next?
“Does your partner snore heavily?” “Do you get exercise during the day?” “How many pillows do you sleep on?” “Do you eat large meals right before bed?”
The nurse is assessing a six-month-old infant at the clinic. When the nurse strokes from the heel of the foot upward toward the ball, the infant exhibits no movement. Which action is the priority for the nurse?
take the infant’s vital signs order a neurology consult examine the infant’s nose and ears ask how much formula the infant consumes daily
The nurse is caring for a client with deep vein thrombosis (DVT). Which should be included in the plan of care?
bed rest with the affected extremity elevated bed rest with the bed in reverse Trendelenburg walking slowly in the hall with assistance to prevent pneumonia sitting up in the chair for all meals and during visitation time