The nurse realizes that a patient receiving chemotherapy for cancer is at risk for developing an infection. What action should the nurse take when caring for this patient? Select all that apply.
A. Monitoring red blood cell counts monthly
B. Teaching the patient to apply lotion daily to clean skin to prevent drying
C. Encouraging the patient to consume a diet high in protein and vitamin C
D. Teaching the patient to report an oral temperature above 98°F
E. Teaching the patient to avoid small children
Answer: E
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Parents ask a nurse how they should reply when their child, diagnosed with schizophrenia spectrum disorder, tells them that voices command him to harm others. Which is the appropriate nursing response?
1. "Tell him to stop discussing the voices." 2. "Ignore what he is saying, while attempting to discover the underlying cause." 3. "Focus on the feelings generated by the hallucinations and present reality." 4. "Present objective evidence that the voices are not real."
A patient is admitted with lower abdominal pain and nausea. The nurse performing the initial assessment notes that the patient's abdomen is distended and firm, and hypoactive bowel sounds are present. The patient has not had a stool for 3 days
The nurse will contact the provider, who will: a. order a bulk-forming laxative. b. order extra fluids and fiber. c. perform diagnostic tests. d. prescribe a cathartic laxative.
Which of the following individuals is likely at the highest risk for orthostatic hypotension?
A) A 75-year-old woman who uses a walker B) An 80-year-old man who strains to void when using the bedside commode C) A 60-year-old who has a long leg cast on his right leg D) An 80-year-old woman who is taking Premarin
A 52-year-old male client who has a history of alcohol dependence is admitted to a detoxification unit
He has tremors, he is anxious, his pulse has risen from 98 to 110 beats/min, his blood pressure has risen from 140/88 to 152/100 mm Hg, and his temperature is six tenths of a degree above normal. He is slightly diaphoretic. Which nursing diagnosis would be the priority? A) Disturbed Thought Processes B) Risk for Injury C) Ineffective Coping D) Ineffective Denial