A client is receiving treatment for the diagnosis of hemophilia. Which of the following should the nurse assess in this client?
1. Appetite
2. Urine output
3. Muscle and joint pain
4. Respiratory rate
3
The clinical features of hemophilia include joint and muscle hemorrhages. The weight-bearing joints are most frequently affected. The nurse should assess the client for muscle and joint pain, which occurs with bleeding. Appetite, urine output, and respiratory rate are not specifically affected by hemophilia.
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Which assessment question should the nurse ask? a. "Are you taking a nonsteroidal anti-inflammatory drug?" b. "Do you have a mental health disorder?" c. "Are you able to swallow medications?" d. "Do you smoke cigarettes or any illegal drugs?"
The nursing unit is informed early in the shift that the computers will be unavailable for four hours during the middle of the shift. What will the nurse manager tell the staff to do regarding documentation of patient care during this time period?
1. Make good notes and document care during the next working shift. 2. Anticipate care to be administered during downtime and document before the computers go down. 3. Make notes and document all care as soon as the computers come back up. 4. Use the downtime documentation described in facility policy.
When studying for the NCLEX-RN exam, the new graduate should be able to determine which tasks to delegate to which employee. Which task would require an intervention if performed by the UAP?
a. Obtaining vital signs on a patient before she leaves the unit for an echocardiogram b. Teaching a patient how to use a multidose inhaler c. Obtaining vital signs on a patient after infusion of 1 unit of PRBCs d. Obtaining a blood glucose level on a patient receiving sliding scale insulin
The nurse provides intravenous dexamethasone (Decadron) 10 mg to a patient with a metastatic brain tumor
What patient outcomes would indicate that the medication is effective? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Neurologic symptoms improve within 12 hours 2. Reduced intracranial pressure 3. Neurologic symptoms improve immediately 4. Reduced respiratory rate 5. Increased heart rate and blood pressure