The nurse is performing a health history to determine the patient's cognitive status. Which questions will be best suited to elicit the information needed? (Select all that apply.)
a. "Are you able to drive to the store or do errands?"
b. "Do you live with anyone?"
c. "Do you ever feel sad?"
d. "Are you able to smell different foods?"
e. "Have you noticed any difficulty adding up numbers?"
ANS: A, E
Smell is a sensory function. Driving and adding numbers relates to cognitive ability. Asking about being sad helps understand mood, and asking if they live with anyone helps understand social status.
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The nurse is working with the parents of a child with a chronic condition. The nurse concludes that the parents' caregiver burden might become overwhelming when the mother states which of the following?
1. "My mother moved in and helps us with the care of our family." 2. "I chose to quit my job to be home with my child, and my husband helps in the evening when he can." 3. "I have to care for my child day and night, which leaves little time for me." 4. "Our health insurer sent us a rejection letter for my child's brand-name medication, and we must fill out forms to get the generic."
A nurse is caring for a 45-year-old patient with acute respiratory distress syndrome (ARDS). The nurse is aware that this disease is characterized by what?
A) Accumulation of copious amounts of very thick secretions in the lungs B) Loss of elastic tissue of the lungs and destruction of alveolar walls C) Progressive loss of lung compliance and increasing hypoxia D) Reversible bronchospasm, inflammation, and hyperactive airways
The nurse asks a client how she is feeling, and the client provides a detailed description of everything she is experiencing. This is an example of:
a. Echolalia b. Circumstantiality c. Neologism d. Perseveration
A client with a mechanical bowel obstruction reports that the abdominal pain that was previously intermittent and colicky is now more constant. What would be the nurse's priority action?
A. Measure the abdominal girth. B. Notify the health care provider. C. Place the client in a knee-chest position. D. Medicate the client with an opioid analgesic.