Fundamental Skills
The nurse is caring for a client with a temperature of 104.5 degrees Fahrenheit (40.3 degrees Celsius). The nurse applies a cooling blanket and administers an antipyretic medication. The nurse explains that the rationale for these interventions is to do what?
Reduce brain metabolism and limit hypoxia
When trying to promote effective learning in a client with a newly diagnosed disease, what should the nurse consider?
Client's past experiences
The nurse manager asks the nurse, "How would you implement clinical decision making in a group of clients?" Which answer provided by the nurse shows effective critical thinking? Select all that apply.
"I will discuss complex cases with other members of the healthcare team." "I will identify the nursing diagnoses and collaborative problems of each client." "I will consider the period it takes to care for clients whose problems have higher priority."
When assessing a client's blood pressure, the nurse notes that the blood pressure reading in the right arm is 10 mm Hg higher than the blood pressure reading in the left arm. The nurse understands what about this finding?
It is a normal occurrence.
The registered nurse is teaching a nursing student about the process of medication reconciliation for a client who was admitted in a healthcare setting. Which statement made by the nursing student indicates a need for further education?
"I should avoid asking about the over-the counter medications."
A client reaches the point of acceptance during the stages of dying. What response should the nurse expect the client to exhibit?
Detachment
The nurse listens to and validates the feelings expressed by a confused older adult. Which elements does the nurse convey in this situation? Select all that apply
Respecting Reassuring Understanding
The nurse is caring for a community-dwelling older adult who is suffering from confusion. Which are the best nursing interventions in this situation? Select all that apply.
The nurse should promote activities that reinforce reality. The nurse should provide a protective environment. The nurse should assist with personal hygiene.
A client is receiving therapy that includes a radioactive sealed implant. What nursing intervention should be implemented to protect against exposure to radiation?
Using long-handled forceps to retrieve a dislodged implant
The nurse is communicating with an older adult who has a hearing disability. Which intervention by the nurse is beneficial to promote communication? Select all that apply.
giving the client a chance to speak making sure that the client knows you are speaking keeping the communication concise
A nurse applies an ice pack to a client's leg for 20 minutes. The cold application will cause what physiologic effect?
local anesthesia
The nurse is assessing four clients. Which infant has exhibited a gross-motor skill?
sits up alone without support