The question of highest priority a nurse should ask a newly admitted client with a history of alcohol
abuse is
a. "Has drinking caused you any problems?"
b. "Have you ever had blackouts?"
c. "When did you take your last drink?"
d. "When did you decide to seek treatment?"
C
Learning when the client had the last drink is essential to knowing when to begin to observe for
symptoms of withdrawal. The other questions are relevant but of lower priority.
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What is the nurse's highest priority when caring for a patient after a TCA overdose?
a. Frequently monitor blood pressure and heart rate/rhythm. b. Monitor for skin rashes, particularly on the torso. c. Measure and record intake and output every 12 hours. d. Institute cooling blankets for hyperthermia.
Which of the following strategies would contribute to maintaining safety in the home?
A) Remove labels from containers and refill for recycling. B) Keep plants in the home. C) Use overloaded outlets when necessary. D) Always pull a plug at the plug-in from the wall outlet.
A person whose husband is terminally ill says, "I don't want to cry in front of him. I don't want him to know how close he is to death or how sad I am." Which response by the nurse would be most therapeutic?
a. "You're right to protect him at a time when he is so vulnerable." b. "He might be more reassured than disturbed by your tears." c. "It's important for you to know that time is running out." d. "You definitely need to be honest about your feelings."
Brenda, a 36 y.o. patient is on your floor with acute pancreatitis. Treatment for her includes:
A. Continuous peritoneal lavage B. Regular diet with increased fat C. Nutritional support with TPN D. Insertion of a T tube to drain the pancreas