The nurse is assessing a client scheduled for a lumbar puncture. Which clinical manifestation assessed by the nurse complicates the lumbar puncture procedure?
a. Normal intracranial pressures
b. Allergy to iodine or shellfish
c. Restlessness and agitation
d. Eating lunch less than 2 hours ago
C
Clients must be able to hold still during the procedure. If a client is restless or agitated, assistance may be needed to ensure that the procedure is completed safely. Lumbar puncture is not per-formed on clients with severely high intracranial pressure. Allergies to iodine and shellfish or eating lunch 2 hours before the procedure have no effect on the procedure.
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A nurse manager institutes the Fulmer Spices Framework as part of the routine assessment of older adults in the hospital. The nursing staff assesses for which factors? (Select all that apply.)
a. Confusion b. Evidence of abuse c. Incontinence d. Problems with behavior e. Sleep disorders
What would help the child with a serious burn meet nutritional needs during the subacute phase of recovery?
a. Decrease calories because the child will be on bed rest and will not need as many. b. Increase calories and protein to compensate for the healing process. c. Increase fat to replace the layer of fat next to the burned skin. d. Decrease carbohydrates and starches because the pancreas is strained by the healing process.
The nurse determines that a child's intravenous infusion has infiltrated. The infused solution is a vesicant. What is the most appropriate nursing action?
a. Stop the infusion and apply ice. b. End the infusion and notify the practitioner. c. Slow the infusion rate and notify the practitioner. d. Discontinue the infusion and apply warm compresses.
The overuse of a drug for non-medical or non-therapy effects is:
a. Drug tolerance b. Drug addiction c. Drug abuse d. Therapeutic drug use