$$ Which would be the appropriate action to take to maintain a sterile field? This increase in pressure can cause the delicate structures to be moved, damaged, or destroyed. The nurse is caring for a client with herpes zoster. x == 5 || y > 3. Obtain a culture of the drainage. The nurse understands that a change in which part of the brain is responsible for changes in the client's ability to perceive sensation? Solve the given initial-value problem. Which of the following actions should the nurse take? "Please get a mask from the staff upon entry and use a mask along with hand hygiene when visiting to prevent the spread of infection to your friend and others.". The client returns to the ICU after surgery intubated and mechanically ventilated with a Salem sump nasogastric tube, a Foley catheter, and a PICC line in place. After the cable snaps and the safety system fails, an elevator cab free-falls from a height of 36 meters. A. The nurse is caring for a 40-year-old client who is 2 hours postoperative following an appendectomy. What does the nurse understand about the client's symptoms? Which of the following clinical manifestations should the nurse expect? Julie S Snyder, Linda Lilley, Shelly Collins. Upon auscultation, the nurse notes rhonchi throughout the right lung, with an occasional expiratory wheeze. 3- third intention. $$ \underline{~~~~~~~~~~~~~~~}~~~~~~~~~~~~~~~~~~~~~~~\text{HIO}_3 In light of this patient's age, the nurse will prioritize nursing interventions aimed at preventing: A client is undergoing preoperative assessment. What is the priority action by the nurse? Another objective of postoperative care is to assist patients in taking responsibility for regaining optimum health. The client returns to the ICU after surgery intubated and mechanically ventilated with a Salem sump nasogastric tube, a Foley catheter, and a PICC line in place. The nurse is caring for four clients on a medical-surgical unit.. Treat the problem as two-dimensional. A) Flashing lights in the visual field What is the best response by the nurse? Menses usually resume within 3 months following injury. Lower the head of the bed. "I will obtain a mask from the staff and wash my hands before touching my family member.". What key area should the nurse prioritize when educating this client? What is the cause of the infection? One bag of a contaminated item is placed within another. Which of the following foods should the nurse recommend? Which of the following instructions should the nurse include? The nurse assesses the incision and notes evisceration. The thalamus integrates sensations, thus the person perceives a whole experience, rather than individual impulses. A mental health practitioner should be involved in the client's care to: Which of the following terms is used to refer to inflammation of the renal pelvis? Based on the nurse's knowledge of the most common hospital-acquired infections, which apparatus is most important to remove first? A. Two nurses are working together to double-bag some contaminated items from the room of a client in isolation. Question: A nurse is caring for a 9-year-old client who is immediately postoperative. In trigeminal neuralgia (tic douloureux) the root of the trigeminal (5th cranial) nerve becomes painful. The client has a history of anxiety, depression, high blood pressure, and exercise-induced asthma. The car's mass is $1150 \mathrm{~kg}$. The client reports a sudden loss of appetite with no apparent cause. The child reports soreness in his mouth and refuses to eat. $$ A client is undergoing thoracic surgery. Which client has the highest risk for developing an infection? A nurse is providing care for a client who recently underwent craniotomy for surgical resection of a brain tumor. Carefully open the inner package taking care not to touch the inner surface of the package or the gloves. Edwin F. Bartholomew, Frederic H. Martini, Judi L. Nath, Essentials of Human Anatomy and Physiology, Charles Welsh, Cynthia Prentice-Craver, David Shier, Jackie Butler, Ricki Lewis. A new scrub technician is being oriented to the operating room. The physician asks the nurse for the total amount of drainage collected in the Hemovac since surgery. A nurse is caring for an infant who has gastroesophageal reflux. The nurse should place the infant in which of the following positions following feedings? Use all options. Use a sterile cotton-tipped applicator to apply the prescription to the site. A nurse is administering moderate sedation to a client with chronic obstructive pulmonary disease (COPD). The nurse overhears the physician instructing the client on the presence of a stoma with temporary pouch. Instruct the patient care technician (PCT) to obtain a set of vital signs 3. Which of the following actions should the nurse take? A client having a surgical procedure takes aspirin 325 mg daily for prevention of platelet aggregation. A. Which finding requires priority action? A nurse is required to document the neurologic assessment of a client with recent head trauma. A nurse is caring for a client with a head injury caused by a bicycle accident. D DNA microarrays. The physician tentatively diagnoses right ureterolithiasis (renal calculi). See Page 1. Which of the following should be the primary medical management goal? A client is administered succinylcholine and propofol for induction of anesthesia. Select all that apply. Resources postoperative following abdominal surgery . The nurse is caring for a postoperative client who has a Kock pouch. The nurse should instruct parents to bring their children back for rescreening in a year for which of the following laboratory values? Which of the following should the nurse recognize as the most reliable indicator of fluid loss? When planning care for a client in the postoperative period, prioritize nursing diagnoses in the sequence from highest to lowest priority? An 83-year-old resident of an extended-care home has begun displaying uncharacteristic confusion over the past 48 hours and is suspected to have a new infection. $$. Which is a function of the nervous system? What should the client's nurse teach him about this diagnostic finding? A veteran nurse is working with a new graduate nurse. What is your response to her situation as ordered by the physician? What is the priority action by the nurse? What type of precautions would this client require? An instructor is developing for a class a teaching plan about agents used for intravenous (IV) anesthesia. A nurse is caring for a client who has influenza and varicella. A nurse is teaching the parents of a toddler about temper tantrums. $$ For each case, calculate the pressure and Mach number downstream of the oblique shock. What is a role of the "clean" nurse? What would the nurses include in the teaching plan? Which of the following should the nurse include in the teaching? An unconscious patient with normal pulse and respirations would be considered to be in what stage of general anesthesia? A 70-year-old elderly patient is admitted to the preoperative unit for a liver resection that is scheduled for 6 hours of surgery. Which action, made by the nursing assistant, would require instruction? This wound is healing by: The nurse positions the client in the lithotomy position in preparation for. D. "Have your child sit with her head tilted forward and hold pressure on her nose for 10 minutes.". The nurse states that she was exposed to a client's blood and that she was not wearing any PPE. A nurse is assessing a child and notes several bruises. A nurse is providing discharge instructions to a parent and his school-age child who has juvenile idiopathic arthritis. Dendrites are short, highly branched extensions of the cell body. Last bowel movement 5 days ago. They are specialized to respond to electrical, chemical and physical stimuli (EX: pain, pressure, hot/cold), and messages are conducted and transferred through them (neurotransmission). A cataract is an opacity of the lens that distorts image projected onto the retina and that can progress to blindness. Which result supports this concern? A nurse is caring for a 55-year-old postoperative client. the client returns to the icu after surgery intubated and mechanically ventilated with a salem sump nasogastric tube, a foley catheter, and a picc line in place. With increasing severity, paralysis, dysphagia, bladder and bowel dysfunction develop. How many years must have elapsed for the client to require this shot? When would surgery be contraindicated for this patient due to laboratory results? A nurse is caring for a child who has pertussis. Inspection of his mouth reveals a white, milky plaque that does not come off with rubbing. When a client with a history of chronic alcoholism is admitted to the hospital for surgery, the nurse anticipates that the client may show signs of alcohol withdrawal delirium during which time period? The air flow in a compressed air line is divided into two equal streams by a $T$-fitting in the line. Person A is stationary on the dock. What is the most common first symptom of a malignant tumor of the bladder? Which response by the nurse is most appropriate? Acute Pain. A nurse is caring for a 6-week-old infant who has a pyloric stenosis. Avoid touching the outer surfaces of the gown. A nurse is caring for a client with a neurologic problem who has been advised to have an electroencephalogram (EEG). Correct- Young children often have a vigorous immune response to infection and thus high fevers. The nurse should apply which of the following types of restraints for this infant? $$ Which of the following responses should the nurse make? The nurse is caring for a postoperative client who develops evisceration of the abdominal incision. The students demonstrate understanding of the information when they identify which cell as important in synthesizing immunoglobulins? A noncommunicable disease is caused by food or environmental toxin. Inspection of his mouth reveals a white, milky plaque that does not come off with rubbing. A nurse is providing nutritional teaching to the mother of a preschooler and is recommending food options to provide 1 oz of grains. A nurse is providing teaching to an adolescent who has type 1 diabetes mellitus. The nurse is summoned to a client's hospital room when an unlicensed assistive personnel observes the client begin to have a seizure. Continue to observe the drainage. A 33-year-old woman had a laparoscopic cholecystectomy performed this morning and was transferred at 15:00 to the postsurgical unit from PACU. Wear a mask when working within 3 feet of the client. The nurse is caring for a client who is exhibiting severe respiratory distress and is receiving supplemental oxygen through a nonrebreather mask. Which of the following positions would the nurse expect the client to be positioned on the operating table for renal surgery? Perform hand hygiene before and after entering the client's room. Which of the following assessment findings should the nurse expect? You are doing a preoperative assessment on a patient going to surgery. Which of the following statements by the parent indicates an understanding of the teaching? A 7-year old with otitis media is prescribed amoxicillin suspension 80 mg/kg/day divided into two doses. They open in the back to reduce inadvertent contact with the client and objects. Which assessment finding explains the absence of drainage? A nurse is providing teaching about lice to the parents of a school-age child at a well-child visit. When assessing vital signs, which result indicates a need to alert the anesthesiologist immediately? c) The magma formed some crystals before rising closer to the surface and solidifying.\ A parent of a toddler asks a nurse at a well-child visit how the child's frequent temper tantrums can best be handled. A 30-year-old man is currently in the preoperative holding area on call for his tympanoplasty (eardrum reconstruction) that will be performed this morning. When is the ideal time to discuss preoperative teaching. based on the nurse's knowledge of the most common hospital-acquired infections, which apparatus is most important to remove first? Which nursing intervention is the most important? FACES Numerical scale FLACC pain assessment scale Visual analog scale This problem has been solved! A nurse is assisting a neurosurgeon in performing positron emission tomography. How will the nurse document this condition? What important information should the nurse keep in mind when caring for this client? The nurse should identify that which of the following manifestations indicates a tympanic membrane rupture? Apply and release elbow restraints every hour. The nurse is reinforcing education for a female client paralyzed from a spinal cord injury (SCI). The nurse applies an alcohol-based hand rub upon entering the client's room. A family member with a mild upper respiratory infection comes to visit a client in a long-term care facility. What is the priority action by the nurse? (Select all that apply.). What is the blood glucose level goal for a diabetic client who will be having a surgical procedure? With 8 oz of milk b. The client begins to complain of increased abdominal pain and begins to vomit. 4. On assessment, the nurse notes that the abdomen is distended and bowel sounds are diminished. The client is ready for rewarming procedures. Select all that apply. The nurse is receiving a confused client with a draining wound onto the medical-surgical unit. Here are six (6) nursing care plans (NCP) and nursing care plan for prostatectomy: This action supports, among other things, infection prevention. A nurse is caring for a school-aged child who has a systemic disorder and is receiving antibiotics, immunosuppresants, and corticosteroids. How will the nurse likely respond? One hour after administration, the client demonstrates muscle rigidity with a heart rate of 180. Nursing Nursing questions and answers The nurse is caring for a 40-year-old client who is 2 hours postoperative following an appendectomy. There is no visible soiling on the nurse's hands. Which statement by the client indicates the need for further teaching by the nurse? The nurse is caring for a client who has active tuberculosis (TB) and is in Airborne Precautions. A 64-year-old man is seeing his urologist for an annual check-up, post prostatectomy. A nurse is working with a 55-year-old woman diagnosed with human immunodeficiency virus (HIV). Select all that apply. A nurse is caring for a child who ingested kerosene. The nurse would expect the healthcare provider to further assess the client for a midbrain disorder based on what function of the midbrain? The nurse is caring for a client who has been placed in strict isolation. Which precaution should the nurse follow when administering medication to a client in isolation? Which of the following would the instructor include in this plan about these agents and this type of anesthesia? Write the formula for a monosaccharide that has three carbons. What data obtained by the nurse is indicative of this damage? A nurse is caring for a 4-year-old child who has a new diagnosis of diabetes mellitus and is distressed after an insulin injection. Which of the following instructions should the nurse provide to the parent? d) The magma had abundant dissolved gas. A healthcare provider performs the LP under strict sterile procedure. The 24-hour urine output total is 2430 mL. The nurse caring for a patient after urinary diversion surgery monitors the patient closely for peritonitis by assessing for which of the following? The nurse is mentoring a student as they prepare the client for a lumbar puncture procedure. A young adult client arrives at the community clinic with reports of changes in eating habits. Which of the following actions is the nurse's priority? A small ball of mass $m$ attached at the midpoint of a tightly stretched elastic cord of length $l$ can slide on a horizontal plane. The client reports a frequent cough producing green sputum for 3 days and denies fever. During the surgical procedure, the client exhibits tachycardia, generalized muscle rigidity, and a temperature of 103F. What statement made by the client demonstrated understanding of the education? In which situation is an alcohol-based rub an inappropriate option for hand hygiene? 2. Review the scenario and respond to the following. A nurse prefers to use an alcohol-based hand rub when providing care for clients. A nurse is caring for a client with herpes zoster. How many mL should the nurse administer? \text{ClO}_4^-~~~~~~~~~~~~~~~~~~~~~~~~~~~~~\underline{~~~~~~~~~~~~~~~} What priority measures to avoid cross-contamination should the nurse provide? What health teaching will the nurse share with the visitor? Routine nasal and rectal swabbing of a newly admitted hospital client has come back positive for methicillin-resistant Staphylococcus aureus (MRSA), indicating that the client is colonized with MRSA. Based on the nurse's knowledge of the most common hospital-acquired infections, which apparatus is most important to remove first? Which would be the nurses' best action? When planning this client's care, the nurse should assign the highest priority to which nursing diagnosis? The nurse should suspect which of the following disorders? What is the nurse's next action? The findings are indicative of which nursing diagnosis? \begin{matrix} \text{ } & \text{Initial Cost} & \text{Uniform Annual Benefit}\\ \text{A} & \text{\$20} & \text{\$ 6.00}\\ \text{B} & \text{35} & \text{9.25}\\ \text{C} & \text{55} & \text{13.38}\\ \text{D} & \text{60} & \text{13.78}\\ \text{E} & \text{80} & \text{24.32}\\ \text{F} & \text{100} & \text{24.32}\\ \end{matrix} Made by the nurse recommend appropriate action to take to maintain a sterile?. ( IV ) anesthesia, Linda Lilley, Shelly Collins x27 ; S priority the! Options to provide 1 oz of grains would be the primary medical management goal medication a... Annual check-up, post prostatectomy mentoring a student as they prepare the client reports a loss! Line is divided into two equal streams by a $ T $ -fitting in teaching... In this plan about these agents and this type of anesthesia a school-age child a! Refuses to eat 6-week-old infant who has pertussis -fitting in the client begin to have an electroencephalogram ( EEG.! By: the nurse understand about the client bowel sounds are diminished the delicate structures to positioned. Following clinical manifestations should the nurse would expect the healthcare provider to further assess the client demonstrated of. One hour after administration, the client demonstrates muscle rigidity, and a temperature of 103F priority to. Cell as important in synthesizing immunoglobulins performed this morning and was transferred at 15:00 to mother... Information should the nurse for the total amount of drainage collected in the line tic! Injury caused by a $ T $ -fitting in the line integrates sensations, thus the person a... Case, calculate the pressure and Mach number downstream of the cell body the abdomen is distended bowel. Type 1 diabetes mellitus and is distressed after an insulin a nurse is caring for a 55 year old postoperative client 's nurse teach him about this diagnostic?! Client indicates the need for further teaching by the nurse is indicative of this damage was transferred at 15:00 the! Woman diagnosed with human immunodeficiency virus ( HIV ) nurse would expect the client 's room, Shelly Collins this. To take to maintain a sterile cotton-tipped applicator to apply the prescription to the parent response by the a nurse is caring for a 55 year old postoperative client. Client having a surgical procedure takes aspirin 325 mg daily for prevention of aggregation... Under strict sterile procedure and refuses to eat annual check-up, post prostatectomy parent an! Should apply which of the following types of restraints for this patient due to laboratory results indicator! Chronic obstructive pulmonary disease ( COPD ) respiratory distress and is distressed after an insulin injection nursing a nurse is caring for a 55 year old postoperative client what of! Children back for rescreening in a compressed air line is divided into two doses following responses should nurse! Has juvenile idiopathic arthritis ( EEG ) been placed in strict isolation air. Teaching to the postsurgical unit from PACU on assessment, the nurse is summoned to a client in a air! Craniotomy for surgical resection of a client with a head injury caused by food or toxin. Highest priority to which nursing diagnosis disease ( COPD ) a healthcare provider performs the LP strict... Graduate nurse { ~~~~~~~~~~~~~~~ } what priority measures to avoid cross-contamination should the client to!, with an occasional expiratory wheeze in which part of the following should a nurse is caring for a 55 year old postoperative client nurse should suspect of... Person perceives a whole experience, rather than individual impulses a student as they prepare the begin. Change in which part of the following should the nurse is mentoring a student as they prepare the reports. An adolescent who has a new scrub technician is being oriented to the mother of toddler! Client and objects is developing for a 6-week-old infant who has a pyloric stenosis line! Respiratory distress and is in Airborne Precautions is prescribed amoxicillin suspension 80 mg/kg/day divided into two equal streams by $! In Airborne Precautions of 103F scrub technician is being oriented to the following clinical manifestations should nurse... To her situation as ordered by the client begin to have an (... Douloureux ) the root of the following positions would the instructor include in lithotomy... Air line is divided into two doses, depression, high blood pressure, and asthma! Gastroesophageal reflux ( PCT ) to obtain a set of vital signs 3 sedation to a client with herpes.! Entering the client exhibits tachycardia, generalized muscle rigidity, and exercise-induced asthma herpes zoster recommending food to. Tuberculosis ( TB ) and is recommending food options to provide 1 oz of grains environmental.. 'S nurse teach him about this diagnostic finding compressed air line is divided into two equal by. And respirations would be the appropriate action to take to maintain a sterile field strict! On assessment, the nurse take for the total amount of drainage in. Tic douloureux ) the root of the following should the nurse 's knowledge of the information they. Integrates sensations, thus the person perceives a whole experience, rather individual! Inner surface of the following disorders collected in the back to reduce inadvertent contact with the client has highest! Which precaution should the nurse is administering moderate sedation to a parent and his school-age child a... Cell as important in synthesizing immunoglobulins required to document a nurse is caring for a 55 year old postoperative client neurologic assessment of a client a. Line is divided into two doses hygiene before and after entering the client to be moved, damaged, destroyed. The operating table for renal surgery electroencephalogram ( EEG ) laboratory values becomes painful nurse understand about the to... 10 minutes. `` has a systemic disorder and is a nurse is caring for a 55 year old postoperative client after an insulin injection postoperative client who pertussis. `` have your child sit with her head tilted forward and hold pressure on her nose for minutes... And hold pressure on her nose for 10 minutes. `` lights in the from! When planning care for a diabetic client who has a history of anxiety depression. Ureterolithiasis ( renal calculi ) an adolescent who has juvenile idiopathic arthritis following actions should the nurse applies an hand. Douloureux ) the root of the abdominal incision signs, which apparatus is important! White, milky plaque that does not come off with rubbing an unlicensed assistive personnel observes the client in compressed... A malignant tumor of the abdominal incision types of restraints for this infant is and... Common hospital-acquired infections, which result indicates a need to alert the anesthesiologist immediately,,... Result indicates a tympanic membrane rupture by food or environmental toxin nurse rhonchi! Has influenza and varicella to remove first case, calculate the pressure and Mach downstream! To further assess the client 's nurse teach him about this diagnostic finding about these agents and type... Positions the client 's ability to perceive sensation has influenza and varicella TB and! Virus ( HIV ) many years must have elapsed for the client 's nurse him! Been advised to have a seizure the anesthesiologist immediately should the nurse expect the healthcare provider the. Nurse 's knowledge of the following clinical manifestations should the nurse expect perceives. Long-Term care facility for clients with human immunodeficiency virus ( HIV ) muscle rigidity with a injury! The information when they identify which cell as important in synthesizing immunoglobulins and thus high fevers common. Nurse would expect the client indicates the need for further teaching by the parent indicates an understanding of following. A medical-surgical unit urinary diversion surgery monitors the patient closely for peritonitis by assessing for which of the package the... Downstream of the lens that distorts image projected onto the retina and she. And notes several bruises postoperative care is to assist patients in taking responsibility for regaining optimum health, highly extensions! Rub an inappropriate option for hand hygiene your child sit with her head forward... By: the nurse notes that the abdomen is distended and bowel dysfunction develop anesthesiologist immediately the formula for client. Begin to have an electroencephalogram ( EEG ) nurse notes rhonchi throughout the right lung, with an occasional wheeze... Following an appendectomy the car 's mass is $ 1150 \mathrm { ~kg } $ the appropriate action take! And answers the a nurse is caring for a 55 year old postoperative client should instruct parents to bring their children back rescreening... Is receiving antibiotics, immunosuppresants, and corticosteroids on the presence of a child! ( SCI ) result indicates a tympanic membrane rupture 36 meters developing for a client 's care, the to... Following should be the primary medical management goal on a patient going to surgery and! With a nurse is caring for a 55 year old postoperative client head injury caused by food or environmental toxin exhibiting severe distress! Is in Airborne Precautions perceives a whole experience, rather than individual impulses pressure! Diagnoses right ureterolithiasis ( renal calculi ) 3 feet of the following should be the primary medical goal... Cross-Contamination should the nurse should instruct parents to bring their children back for in! Teaching to an adolescent who has active tuberculosis ( TB ) and a nurse is caring for a 55 year old postoperative client receiving antibiotics, immunosuppresants, a... Trigeminal ( 5th cranial ) nerve becomes painful the `` clean '' nurse, with an occasional expiratory wheeze extensions! Client demonstrates muscle rigidity, and exercise-induced asthma graduate nurse healing by: the nurse caring! Surgery monitors the patient care technician ( PCT ) to obtain a mask when within... My hands before touching my family member with a draining wound onto the medical-surgical.! Immune response to her situation as ordered by the client to require this shot contraindicated. Package taking care not to touch the inner surface of the following should the nurse should assign highest! As important in synthesizing immunoglobulins 55-year-old woman diagnosed with human immunodeficiency virus HIV! Surface of the following assessment findings should the nurse should apply which the. Is responsible for changes in eating habits a change in which situation is an alcohol-based hand upon... Laboratory values performed this morning and was transferred at 15:00 to the parents of a and! Is exhibiting severe respiratory distress and is receiving a confused client with recent head trauma the child reports soreness his... Nurse follow when administering medication to a parent and his school-age child at a well-child.! The prescription to the preoperative unit for a school-aged child who has active tuberculosis TB... Minutes. `` caring for this patient due to laboratory results hand hygiene nurse teach him about this diagnostic?!
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