The nurse is caring for a patient at risk for sensory deprivation. What interventions should the nurse implement to decrease the patient's risk? Select all that apply
A) Encouraging the patient's family to bring in personal objects.
B) Keeping the television on at all times
C) Placing a clock and calendar in the patient's room
D) Brushing the patient's hair
E) Speaking slowly and clearly to the patient
Ans: A, C, D, E
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The laboring client presses the call light and reports that her water has just broken. The nurse's first action would be to:
1. Check fetal heart tones. 2. Encourage the mother to go for a walk. 3. Change bed linen. 4. Call the physician.
Which of the following nursing diagnoses would the nurse expect for a client with a decreased erythropoietin production?
1. Risk for Injury 2. Risk for Fluid-Volume Deficit 3. Risk for Infection 4. Risk for Altered Nutrition
A mother and her newborn have been discharged after a hospital stay of less than 48 hours
What are essential components the nurse must include in the first postpartum home visit? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Assessment of color 2. Measurement of weight 3. Measurement of height 4. Assessment of mother–newborn interaction 5. Reinforcement of information about feeding and sleep patterns
When assessing a patient's tracheostomy site, the nurse notes redness and inflammation around the stom
a. Which intervention can the nurse provide to address this problem? a. Decrease the frequency of tracheostomy care. b. Apply a dry gauze dressing just under the stoma. c. Remove the ties at frequent intervals. d. Apply a topical antibacterial solution and allow it to dry.