A patient is shouting loudly and is verbally aggressive. What analysis should the nurse make about this behavior?
a. It is acceptable if directed toward staff but not toward another patient.
b. It is not harmful and might prevent the patient from physically acting out.
c. It is a significant warning sign that the patient may become physically aggressive.
d. It allows the patient to vent frustration and alleviate stress without hurting anyone.
C
Research findings indicate that verbally aggressive attacks on others are among the major warning signs of assault and battery, making the other answers mutually exclusive. Verbal aggression is part of the assault cycle.
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a. Dairy products are encouraged. b. No added salt is required. c. Low roughage should be followed. d. Protein foods are restricted.
A home health nurse is visiting a client living with his parents who has severe depression and is considered at risk of suicide. When the client refuses to sign a "no harm" contract, the most ap-propriate action by the nurse is to
a. call 911, explaining that there is a psychiatric emergency. b. instruct family members to keep a close watch on the client. c. schedule another visit for the following day. d. telephone the physician for a referral to a psychiatric nurse.
What teaching is appropriate for a client with acute rhinitis and sinusitis? (Select all that apply.)
a. Using hot packs over the sinuses b. Fluid restriction c. Saline irrigations d. Staying in a dry climate e. Taking echinacea f. Antifungal medications
The nurse is caring for an 18-month-old child with rotavirus. What clinical manifestations should the nurse expect to observe?
a. Severe abdominal cramping and bloody diarrhea b. Mild fever and vomiting followed by onset of watery stools c. Colicky abdominal pain and vomiting d. High fever, diarrhea, and lethargy