The nurse is assisting with a patient admission to the telemetry unit. The patient is diagnosed with angina pectoris. When obtaining information for angina therapy in regard to the central nervous system (CNS), the nurse will document
a. history of smoking.
b. diet.
c. anxiety level.
d. heart rate.
ANS: C
Anxiety level is a component of assessing the CNS. History of smoking is included when assessing the cardiovascular system. Diet is included when assessing nutritional history. Heart rate is included when assessing the cardiovascular system.
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The nurse is caring for a patient admitted to the hospital with a fractured femur and possible head injury. Vital signs on admission were blood pressure 128/72 mm Hg, pulse 90 beats/min, and respirations 66 breaths/min
Four hours after admission, the nurse is checking vital signs as part of the hourly assessment. Which of the following vital signs most likely indicate the presence of increased intracranial pressure (ICP)? a. Blood pressure 172/68 mm Hg, pulse 42 beats/min, respirations 10 breaths/min b. Blood pressure 160/90 mm Hg, pulse 112 beats/min, respirations 16 breaths/min c. Blood pressure 130/72 mm Hg, pulse 50 beats/min, respirations 24 breaths/min d. Blood pressure 100/70 mm Hg, pulse 120 beats/min, respirations 30 breaths/min
Collaborative interventions refer to actions that are prescribed by the ____________________ and implemented by the ____________________
Fill in the blank(s) with correct word
The rehabilitation approach for schizophrenia focuses on developing skills and support for clients in order to be successful while living, learning, and working in the community. The psychiatric nurse knows that rehabilitation is:
A) A necessary evil. B) Not a quick fix. C) A self-enhancing opportunity to socialize with others. D) About making collaborative partnerships.
The nurse should refer which of the following patients to a partial hospitalization program? A patient who:
a. has a therapeutic lithium level and reports regularly for blood tests and clinic follow-up. b. needs psychoeducation for relaxation therapy related to agoraphobia and panic episodes. c. spent yesterday in a supervised crisis care center and continues to have active suicidal ideation. d. states, "I'm not sure I can avoid using alcohol when my spouse goes to work every morning."