,A pt presses the call bell and requests pain medication for a
severe headache. To assess the quality of the pt. Pain, which
approach should the nurse use? - ans Ask the patient to describe
the pain
The nurse is wearing personal protective equipment while caring
for a pt. When exiting the room, which PPE should be removed
first? - ans Gloves
An older pt is brought to the ED with a sudden onset of confusion
that occurred after experiencing a fall at home. The daughter,
who has power of attorney, has brought the client's prescriptions.
Which information should the nurse provide first when reporting
to the healthcare provider using SBAR communication? - ans
Increasing confusion of the pt.
A pt tells the nurse about working out with a personal trainer and
swimming three times a week in an effort to lose weight and
sleep better. The pt states that it still is taking hours to fall asleep
at night. Which action should the nurse implement? - ans Ask the
pt for a description of the exercise schedule that is being followed
2 days prior to discharge from the rehab facility, the nurse is
teaching a pt who is recovering from Guillain-Barre syndrome
about home. Which actions should the nurse include when
providing discharge teaching to the pt and spouse? SATA - ans -
review safe transfer strategies
-develop a nutritional plan
-help identify community support
The nurse implements a tertiary prevention program for type 2
diabetes in a rural health clinic. Which outcome indicates that the
,program was effective? - ans pt who develop disease
complications promptly received rehabilitation
The nurse has received funding to design a health promotion
project for African American women who are at risk for
developing breast cancer. Which resource is most important in
designing this program? - ans participation of community leaders
in planning the program
The nurse is taking the blood pressure measurement of a client
with Parkinson's disease. Which information in the admission
assessment is relevant to the nurse's plan for taking the blood
pressure reading? SATA - ans Blurred Vision
Flat Affect
frequent syncope
After administering a proton pump inhibitor, which action
should the nurse take to evaluate the effectiveness of the
medication? - ans Ask the pt about gastrointestinal pain
A pt is receiving enoxaparin 30 mg subcutaneously twice a day.
In assessing for adverse effects of the medication, which serum
laboratory value most important for the nurse to monitor - ans
platelet count
A pediatric client is taking the beta-adrenergic blocking agent
propranolol. In developing a teaching plan, the nurse should
teach the parents to report which sign of overdose? - ans
Bradycardia
, The nurse is demonstrating correct transfer procedures to the
unlicensed assistive personnel working on a rehab unit. The UAP
asks the nurse how to safely move a physically disabled pt from
the... wheelchair to the bed. Which action should the nurse
recommend? - ans Place the pt locked wheelchair on the pt strong
side next to the bed
The nurse has completed the diet teaching of a client who is being
discharged following tx of a leg wound. A high protein diet is
encouraged to promote wound healing. Which lunch choice by
the pt indicates that the teaching was effective? - ans A tuna fish
sandwich with chips and ice cream
When conducting diet teaching for a pt who was dx with a
myocardial infarction, which snack foods should the nurse
encourage the pt to eat? SATA - ans Fresh Turkey slices and
berries
chick bouillon soup and toast
raw unsalted almonds and apples
A pt taking clopidogrel reports the onset of diarrhea. Which
nursing action should the nurse implement first? - ans Observe
the appearance of the stool
A pt is dx with Meniere's disease. Which problem should the
nurse identify as most important in the plan of care? - ans Risk for
injury related to vertigo
A new nurse preparing to irrigate an IV catheter is attaching a 24
gauge needle. Which action should the charge nurse implement? -
ans Suggest the nurse use 20g needle
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