The nurse is assessing a client who had a dissection of all branches of the right trigeminal nerve. When asked to wrinkle his forehead, the client wrinkles only the left side. Which is the nurse's best action?
a. Place the client in high Fowler's position.
b. Document the finding.
c. Assess the corneal reflex.
d. Notify the health care provider.
B
Loss of motor and sensory function after complete trigeminal nerve dissection is normal. No in-tervention is necessary.
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The nurse in a pediatric acute-care unit is assigned the following tasks. Based on recognition that the action defined requires training beyond the preparation of a registered nurse, the nurse would refuse to
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