The nurse prepares to discharge to home the older client who has fallen in the hospital. Which safety measure does the nurse include in client and family teaching?
1. Install timers on the lights to illuminate pathways.
2. Take all diuretics and antihypertensives at bedtime.
3. Install additional towel bars near the shower or tub.
4. Wear thin, firm-soled shoes covering the entire foot.
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4. The nurse instructs the client to wear thin, firm-soled shoes covering the entire foot when ambulating to help prevent falls. Most people think thick, rubberized soles are the best protection against falls, but nursing research indicates that these soles in-crease the client risk of falls because the client is more likely to catch the toe and trip over a hazard. Thin, firm soles glide over small hazards on which a rubberized sole catches and potentially causes a fall. For added safety, the client should wear shoes with ties; a low-heeled, tie-on Oxford shoe with a leather sole is an example of a very safe shoe.
1. The nurse instructs the client to illuminate pathways to help clients visualize the path; controlling lights with a timer makes illuminating an area more difficult for the client and increases the risk of falls if the client decides turning on the light is too much trouble.
2. The nurse instructs the client to take diuretics and antihypertensives in the morning so the client can sleep through the night and not rush to the bathroom.
3. Towel bars are ineffective safety bars; the nurse instructs the client to install safety bars in the bathroom.
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a. "borborygmi present" b. "rebound tenderness" c. "separation of the rectus abdominis muscle in the RLQ" d. "tympany present"
A nurse accidentally spills some powdered antineoplastic drugs on the floor when removing them from the storage cabinet. Which of the following actions should the nurse take to clear the drug spill?
A) Display a warning sign in the spill area. B) Take action to ensure the powder is not spread. C) Use a vacuum cleaner to clear the spill. D) Wash the spill area with normal saline.
A patient with pheochromocytoma is admitted for surgery. The surgeon has ordered an alpha-blocking agent to be given preoperatively. What does the nurse understand about this agent?
a. It is ordered to prevent perioperative hypertensive crisis. b. It prevents secretion of catecholamines by the adrenal tumor. c. It reduces contraction of smooth muscles in the adrenal medulla. d. It is given chronically after the surgery to prevent hypertension.
The nurse is witnessing an adult patient's surgical consent. What should the nurse confirm before witnessing the surgical consent? (Select all that apply.)
a. The patient's next of kin b. When the patient last ate or drank c. The last time a sedative was administered d. Whether the patient is informed about the surgery e. If family members have questions related to the surgery