When preparing to test a client for meningeal irritation, which of the following would be most important for the nurse to do first?
A) Check for evidence of fever and chills
B) Ensure no injury to the cervical spine
C) Position the client prone
D) Check for a Babinski reflex
B
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A nurse working with Japanese American adolescents should be aware of nonverbal communication patterns in their culture. While working with these clients, the nurse should:
1. Touch them often during the communication to reassure them. 2. Stand very close to them while talking with them. 3. Shake their hands upon greeting them. 4. Look directly at them while talking with them.
The nurse is assigned to administer medications to all patients throughout the shift. What is this an example of?
A) Team nursing B) Case method nursing C) Primary care delivery D) Functional nursing care
The nurse wishes to test opposition ability in the patient's thumb. How would the nurse instruct the patient?
1. "Touch each one of your fingertips with your thumb.". 2. "Move your thumb across your palm away from the rest of your fingers.". 3. "Move your thumb across your palm and touch your fifth finger.". 4. "Move your thumb anteriorly away from the palm and then back.".
A patient is taking digoxin (Lanoxin) and a
loop diuretic daily. When the nurse enters the room with the morning medications, the patient states, "I am seeing a funny yellow color around the lights." What is the nurse's next action? a. Assess the patient for symptoms of digoxin toxicity. b. Withhold the next dose of the diuretic. c. Administer the digoxin and diuretic together as ordered. d. Document this finding, and reassess in 1 hour.