You have just completed the change-of-shift report. Which of the following clients would you see first?
a. An elderly client who needs help with transferring to the commode
b. A client admitted 2 hours earlier after receiving 2nd-degree burns on his face and torso
c. An obese client who needs assistance with changing position
d. A client who is 2 days post-op and has an IV that has infiltrated
B
You should see the client admitted 2 hours earlier with burns to the face and torso. This type of burn
injury has the potential for compromising the client's ability to breath. The client's respirations and
oxygen saturation level must be assessed. Following the ABC's of prioritizing, this client becomes the
priority.
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A nurse caring for a 9-year-old notices some swelling in the child's ankles. The nurse presses against the ankle bone for five seconds, then releases the pressure, noticing a markedly slow disappearance of the indentation
Due to these physical findings, the nurse would be most concerned with assessing: 1. Skin integrity, especially in the lower extremities. 2. Urine output. 3. Level of consciousness. 4. Range of motion and ankle mobility.
A nursing student is studying for a test and asks you to explain to her the difference between acute and chronic renal failure. She states, "Isn't it all the same, I mean don't they all go on dialysis?"
a. How would you explain to her the difference between acute and chronic? b. What are the signs and symptoms of each?
The nurse working in the well-baby clinic prepares to administer immunizations to a four-month-old infant including:
a. DTaP #2, Hib #2, Varicella, PCV #2. b. Hep B #2, DTaP #2, IVP #1, PCV #1. c. Hep B #2, DTaP #1, IPV #2, MMR. d. DTaP #2, Hib #2, IPV #2, PCV #2.
Avoid making comparisons between people.
Answer the following statement true (T) or false (F)