HURST 2
The edrophonium (Tensilon) test has been prescribed for a client. Which statement by the client would indicate to the nurse that the client understands this test?
"I will be asked to perform a repetitive movement to test my muscles."
A client presents in the emergency department with acute onset of fever, headache, stiff neck, nausea/vomiting, and mental status changes. What interventions should the nurse initiate?
1. Provide a quiet environment 2. Pad side rails 3. Place on droplet precautions 4. Maintain head in midline position (Tepid sponge bath will also help-not ice packs)
The family of a bedfast 80 year old is providing care in the home. Which reports by the family indicate adequate understanding of interventions that will reduce the risk for skin breakdown?
1. I make sure that the sheets and the foam pad in the chair stay dry. . 3. The perineal area should be kept dry and clean. 4. My parent eats 2 meals per day and drinks a supplement. 5. I may reposition my parent more than every 2 hours if their perception of pressure is intact.
A nurse is educating a group of community citizens about risk factors for developing peripheral neuropathy. Which risk factors should the nurse include?
1. Uncontrolled diabetes 2. Alcohol abuse 4. Rheumatoid arthritis 5. Varicella-zoster virus
What dietary information should the nurse provide to a client diagnosed with Celiac disease?
2. "Creamed based canned soups are a source of hidden wheat." 3. "You can eat foods containing fax, corn, or rice." 4. "Avoid foods and beverages that contain malt." 5. "Do not eat traditional wheat products such as pasta."
A client is being cared for on the orthopedic unit following a football game injury which resulted in a fracture of the left tibia and fibula. An open reduction of the fracture has been performed and a leg cast was applied. The client is receiving Morphine via a Patient Controlled Analgesia (PCA) pump at 2 mg/hr. The client begins reporting an increase in the pain level (9/10) that is not being relieved by the current Morphine dosing, and is experiencing a sensation that "pins are sticking" in the left foot. What action by the nurse is needed?
3. Perform neurovascular checks. 5. Prepare for possible bivalving of the cast. 6. Notify primary healthcare provider.
The nurse is discussing frostbite prevention with a group of teenagers who participate in cold weather activities. What information should the nurse provide?
3. Eat well-balanced meals. 5. Wear a wool headband over the ears
What signs and symptoms does the nurse expect a client diagnosed with bacterial pneumonia to exhibit?
dyspnea tachy pleuritic chest discomfort increased tactile fremitus
diverticulitis teaching
lots of fluid ATB same time daily rest and mild exercise increase fiber