The nurse is taking the health history of a client suspected of having bacterial meningitis. Which question is most important for the nurse to ask?
a. "Do you live in a crowded residence?"
b. "When was your last tetanus vaccination?"
c. "Have you had any viral infections recently?"
d. "Have you traveled out of the country in the last month?"
A
Meningococcal meningitis tends to occur in outbreaks. It is most likely to occur in areas of high-density population, such as college dormitories, prisons, and military barracks. The other questions do not identify risk factors for bacterial meningitis.
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A hospitalized client's strength of the upper extremities is rated at 3. What does the nurse understand about this client's ability to perform activities of daily living (ADLs)?
a. The client is able to perform ADLs but not lift some items. b. No difficulties are expected with ADLs. c. The client is unable to perform ADLs alone. d. The client would need near-total assistance with ADLs.
A prescriber orders sumatriptan [Imitrex] for a patient for a migraine headache. Before administration of this drug, it would be most important for the nurse to assess whether the pa-tient:
a. has a family history of migraines. b. has taken acetaminophen in the past 3 hours. c. has taken ergotamine in the past 24 hours. d. is allergic to sulfa compounds.
A patient asks the nurse if any of the antihistamines are available as a nasal spray. Which of the following medications should the nurse instruct the patient to discuss with the prescriber?
a. Azelastine (Astelin) b. Mometasone (Nasonex) c. Sertraline (Zoloft) d. Ipratropium bromide (Atrovent)
When the nursery nurse auscultates a newborn's heart rate at 138 beats per minute, the nurse should:
A) document the normal finding. B) notify the pediatrician. C) assess for respiratory distress. D) assess for rhythm.