A nurse cares for a client who is experiencing epistaxis. Which action should the nurse take first?
a. Initiate Standard Precautions.
b. Apply direct pressure.
c. Sit the client upright.
d. Loosely pack the nares with gauze.
ANS: A
The nurse should implement Standard Precautions and don gloves prior to completing the other actions.
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The nurse is caring for a patient who is being tested for possible myasthenia gravis (MG). What are the most common early symptoms of myasthenia gravis that the nurse should document in the medical record? (Select all that apply.)
a. Weakness b. Nausea c. Numbness of the extremities d. Confusion e. Tremor f. Ptosis
A nurse is applying a 5% permethrin lotion to a toddler with scabies. Which instruction describes the best way to apply this lotion?
1. Apply the lotion over the entire body from the chin down, as well as on the scalp and forehead. 2. Apply the lotion only on the areas with evidence of scabies activity. 3. Apply the lotion only to the hands. 4. Apply the lotion to the scalp only.
A brain (B-type) natriuretic peptide (BNP) sample has been drawn from an older adult patient who has been experienced vital fatigue and shortness of breath. This test will allow the care team to investigate the possibility of what diagnosis?
A) Pleurisy B) Heart failure C) Valve dysfunction D) Cardiomyopathy
Which of the following clients would MOST likely benefit for rehabilitation/restorative care services?
a. 35-year-old client with H1N1 influenza b. 58-year-old client with end-stage renal disease (ESRD) c. 79-year-old client with advanced dementia d. 62-year-old client with left side paralysis resulting from a stroke