Chapter 23 Nursing 102
The community health nurse is talking with four clients. Who does the nurse identify that would most benefit from teaching about alcohol and drug abuse?
19 yo college male majoring in physics
Mr. Ames, age 84, has just been admitted to the hospital for the treatment of pneumonia. In addition to this diagnosis, Mr. Ames also has stage II Alzheimer's disease and is disoriented to place and time. As the night has progressed, he has become increasingly agitated, pulling out his intravenous catheter and wandering throughout the unit. He has become more agitated as the nurses have attempted to reorient and redirect him. Which intervention should the nurses perform?
Position Mr. Ames' bed closer to the nurses' station and perform an assessment.
A nurse is caring for an older adult client at risk of injury due to confusion. The client has a stable gait. Which method of restraining should the nurse use?
alart activating bracelet
A home care nurse provides health education to parents regarding the care of their toddler. Which precaution should the nurse suggest the parents take to protect the toddler from drowning?
avoid unattended baths for toddlers
The nurse is reviewing a healthcare provider's orders in the electronic health record (EHR) and notices several abbreviations. What is the appropriate nursing action?
contact healthcare provider to clarify
A caregiver of a toddler has called the poison control nurse to report that the child licked a small amount of petroleum jelly. The caregiver states that the toddler is sitting on the floor, watching a cartoon, and playing with a toy. Which information will the poison control nurse provide?
dilute with milk and water
The clinical nurse educator at a long-term care facility is responsible for organizing and carrying out staff education sessions. Which topic for staff education is most likely to benefit the greatest number of residents?
educating nurses on how to prevent falls
A nurse finds a client in his room asphyxiated with carbon monoxide (CO) inhalation. Which activity should be the priority for the nurse?
get the victim out of the present environment
Which topic should a public health nurse emphasize when educating older adults on reducing their risk of poisoning?
keeping medications in clearly labeled containers
Use of which restraint requires the nurse to stay with the client until the restraint is discontinued?
mummy restraint
The telehealth nurse receives a call from a caller who states that upon entering the home, two confused family members have been found with a bright cherry red skin color. They are reporting nausea and headache, and are unable to move. Which initial direction will the nurse provide?
open doors and windows
A nurse is admitting a client to a geriatric medicine unit following the client's recent diagnosis of acute renal failure. Which nursing action is most likely to reduce the client's chance of experiencing a fall while on the unit?
orient the client to the room and environment throughly at admission
The nurse educator has just completed a lecture regarding older adults and hazards in the home. The nurse educator recognizes that the education was effective when the students state that common dangers in the home setting of an older adult include:
polypharmacy and the use of multiple extension cords
A nurse is assigned to care for a hospitalized toddler. Which activity should be the highest priority for the nurse?
protect the toddler from injury
A nurse responds to the call bell and finds another nurse evacuating the client from the room, which has caught fire. Which action should the nurse take?
pull the fire alarm lever
The nurse is providing discharge teaching to the family of an older adult client. Which teaching will the nurse include to decrease the risk for electric shock?
refrain from using extension cords
A father asks the nurse who is caring for his 13-year-old daughter why his daughter could be performing poorly in school lately, and why she is distancing herself from friends and family. Which of these possibilities would the nurse consider as the priority risk?
she may be the victim of cyber bullying
The nurse needs to plan the interventions necessary to reduce fall risks for the older adult clients at her facility. Which is the strongest indicator that a client is at risk for falls?
the client has fallen before
There is a fire in the neurology unit of a health care facility. What would be most appropriate to avoid in this situation?
use of elevators
Which age group is most vulnerable to toxic fumes or asphyxiation?
young children
