After the nurse has formulated expected outcomes, the next step of the nursing process is to
A) Outline evaluation strategies
B) Prepare an oral report
C) Document the rationale
D) Write the plan of care
Ans: D
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A patient who arrives in the emergency department complaining of squeezing substernal pain that radiates to the left shoulder and jaw also complains of nausea, diaphoresis, and shortness of breath. What should the nurse do?
A) Complete the patient's registration information, perform an electrocardiogram, gain IV access, and take vital signs. B) Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the physician. C) Gain IV access, give sublingual nitroglycerin, and alert the cardiac catheterization team. D) Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.
A young gay patient being treated for his third sexually transmitted disease does not see why he should use condoms, because "they don't work." The nurse's most appropriate response would be
a. "Condoms may not provide 100% protection, but when used correctly and consistently with every act of sexual intercourse they reduce your risk of getting infected with HIV or other sexually transmitted diseases." b. "You are correct. Condoms don't always work, so your best protection is to limit your number of partners." c. "Condoms do not provide 100% protection, so you should always discuss with your sexual partners their HIV status or ask if they have any STD." d. "Condoms do not provide 100% protection, but when used with a spermicide you can be assured of complete protection against HIV and other STDs."
Which of the following is the most appropriate nursing intervention for the nursing diagnosis of impaired physical mobility relate to fractured hip?
A) Administer analgesics as required. B) Place a pillow between the legs when turning. C) Monitor vital signs. D) Assess wound appearance.
Blood pressure, vascular resistance, and body temperature are decreased and blood flow and heart rate are increased in _____________________.?
A) systemic circulation B) vasoconstriction C) total peripheral resistance D) vasodilatation