Chapters 1&2
The RN is orienting a new nurse who suggests a different way to perform a procedure. What is the RN's most appropriate reaction?
Listen to the new nurse's suggestion and evaluate its usefulness
A 16-year-old client was admitted to the medical unit 1 hour ago for sickle cell crisis. Vital signs are as follows: temperature, 98.24°F (36.8°C) sublingual; heart rate, 95 beats/min; respiratory rate, 20 breaths/min; blood pressure, 130/65 mm Hg. The client rates pain as a 9/10. The nurse is talking with the medical resident on service to discuss client orders. Which order is the nurse likely to request first for the client?
Narcotic analgesic to treat pain
A nursing diagnosis of "Ineffective Coping" has been chosen for a client after receiving a diagnosis of prostate cancer. What assessments would the nurse consider as evidence for this diagnosis? Select all that apply.
-The client reports an inability to get adequate restful sleep. -The client has difficulty concentrating on the details of treatment options. -The client states, "I can't handle all of this."
What common problem is related to outcome identification and planning?
Failing to involve the client in the planning process
The nurse administers pain medication to a postoperative client. Which nursing intervention will assist with the client's unrelieved pain?
Repositioning the client.
Which is an accurately phrased risk nursing diagnosis?
Risk for Falls related to altered mobility
Which statement is true regarding addressing a priority problem?
A priority problem requires a nursing intervention before another problem is addressed.
A nurse is caring for a client who was admitted 2 days ago following surgery. The client has diminished lung sounds in the posterior bases. What is the best action by the nurse?
Encourage hourly use of the incentive spirometer.
A nursing diagnosis is written as Disturbed Body Image related to presence of large scar over left side of face. What does the phrase "Disturbed Body Image" identify?
The health state or problem of the client
