During primary survey assessment of a burn patient, the nurse checks for early signs of carbon monoxide poisoning, which include: (Select all that apply.)
a. dizziness.
b. urticaria.
c. vomiting.
d. headache.
e. vertigo.
f. unsteady gait.
C, D, F
Early signs of carbon monoxide poisoning include headache, nausea, vomiting, and unsteady gait.
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A hospitalized 11-year-old child turns down opportunities to play or engage in diversionary activities. When questioned, the child states "I'm bad at that" or "I can't do anything." What action by the nurse is best?
A. Arrange a pediatric psychology consultation. B. Assess the child for emotional abuse at home. C. Consult the child developmental specialist. D. Document the statements in the child's chart.
The nurse pours normal saline over the client's eye to wash out particles. Which phrase will the nurse use when documenting this procedure?
1. "Moisturized the eye with normal saline" 2. "Instilled normal saline into the eye" 3. "Irrigated the eye with normal saline" 4. "Sterilized the eye with normal saline"
A nurse is caring for a client who is receiving dialysis. An order on the client's chart
reads "Guaiac all stools." What should the nurse do? A) Monitor all stools for consistency and color B) Measure all stools to monitor the output C) Send all stools for occult blood test D) Send all stools for a culture and sensitivity test
The nurse is caring for a patient who has aphthous stomatitis. What care should the nurse provide? (Select all that apply.)
a. Apply a topical anesthetic. b. Teach to avoid irritating foods. c. Place on fluid restriction. d. Suggest stress management techniques. e. Make patient NPO.