A patient acid-base status is changing to alkalotic. The nurse realizes that which of the following electrolytes maintains a normal acid-base balance with chloride and bicarbonate?
1. potassium
2. calcium
3. sodium
4. magnesium
3
Rationale: The major extracellular cation of sodium must be in balance with the two major extracellular anions chloride and bicarbonate. Both chloride and bicarbonate compete for sodium ions. Potassium, calcium, and magnesium do not bind with chloride or bicarbonate to regulate acid-base balance.
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During the physical assessment of the client, the nurse notes that the client is able to shrug the shoulders bilaterally. Based on this data, which nerve is intact?
1. Cranial nerve I (olfactory). 2. Cranial nerve II (optic). 3. Cranial nerve VII (facial). 4. Cranial nerve XI (spinal accessory)
What is the nurse's best proof against malpractice?
a. The nurse supervisor's memory of the event b. Recorded documentation written carelessly c. The nurse's memory of the event d. Recorded documentation of nursing care
The health status of an older patient with liver disease is rapidly deteriorating. There is no documentation on the medical record regarding the patient's care wishes
What should the nurse do to ensure the patient receives care that is desired at the end of life? 1. Ask social services to provide an advance directive for the patient to complete. 2. Talk with the patient regarding what the patient wants after the hospitalization ends. 3. Call a meeting with the patient, family, and primary care physician to discuss care goals. 4. Discuss the patient's dire situation with the family and find out what their wishes might be.
A cognitively impaired older adult patient is a resident at a skilled nursing facility. The nurse acting as the patient's advocate will consistently address the patient's risk for injury issues based on
a. preferences generally expressed by cogni-tive patients. b. professional nursing knowledge. c. implementation of the less restrictive in-tervention. d. established facility policies and proce-dures.