A home care nurse is visiting a client who was discharged to home with a prescription for continued administration of enoxaparin subcutaneously. What is the nurse's priority assessment for this client?
1. Constipation
2. Fear of needles
3. Nausea or vomiting
4. Bleeding gums or bruising
Ans: 4. Bleeding gums or bruising
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A nurse teaches a client with heart failure about energy conservation. Which statement should the nurse include in this client's teaching?
a. "Walk until you become short of breath, and then walk back home." b. "Gather everything you need for a chore before you begin." c. "Pull rather than push or carry items heavier than 5 pounds." d. "Take a walk after dinner every day to build up your strength."
Which respiratory finding would indicate the need for further assessment by the nurse?
1. Regular 2. Quiet 3. Deep 4. Rate of 12-20 per minute
The nurse instructs a client that a normal observation during breast self-examination (BSE) is
a. contour changes. b. dimpling. c. nipple deviation. d. variation in breast size.
A patient has been diagnosed with disseminated intravascular coagulation (DIC). The patient's condition has not improved after administration of fresh frozen plasma and platelets. Which therapy does the nurse anticipate?
1. Administration of heparin 2. Rapid infusion of intravenous normal saline 3. Bone marrow transplant 4. Surgical removal of the spleen