The nurse is caring for a patient with suspected right-sided heart failure. Which manifestation best supports this potential diagnosis?
a. Wheezing
b. Orthopnea
c. Edema
d. Pallor
C
Right-sided heart failure leads to edema from systemic backup. Wheezing, orthopnea, and pallor are indicative of left-sided failure.
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A nurse plans care for a client who is prescribed skeletal traction. Which intervention should the nurse include in this plan of care to decrease the client's risk for infection?
a. Wash the traction lines and sockets once a day. b. Release traction tension for 30 minutes twice a day. c. Do not place the traction weights on the floor. d. Schedule for pin care to be provided every shift.
The nurse is instructing a patient with a compromised immune status on the signs and symptoms of infections. Which of the following should be included in these instructions?
1. cloudy urine 2. increased sputum production 3. purulent wound drainage 4. irritated oral mucosa
A nurse engaged in the preinteraction phase of the nurse-patient relationship will:
a. consider what he or she has to offer the patient. b. form a workable but detailed contract. c. review the general goals of a therapeutic relationship. d. plan for the first interaction with the patient. e. identify existing stressors affecting the relationship.
The nurse is describing the ChooseMyPlate program to a patient. Which statement from the patient indicates successful learning?
a. "I can use this to make healthy lifestyle food choices." b. "I can use this to count specific calories of food." c. "I can use this for my baby girl." d. "I can use this when I am sick."