The nurse notes that a patient who has undergone skin, tissue, and muscle grafting following a modified radical neck dissection requires suctioning. What is the most important consideration for the nurse when suctioning this patient?
A) Avoid applying suction on or near the graft site.
B) Position patient on his nonoperative side with the head of the bed down.
C) Assess viability of the graft before beginning suctioning.
D) Evaluate the patient's ability to swallow saliva and clear fluids.
A
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The new mother tells the nurse that sometimes her infant seems to become frantic when crying and asks what she can do when this happens. Which actions would the nurse recommend? Standard Text: Select all that apply
1. Offer breast or bottle if it has been two hours or longer since the last feeding. 2. If the infant is not hungry or wet, allow the infant to cry it out. 3. Swaddle the infant in a blanket and rock the infant. 4. Try patting the infant on the back to help the baby expel gas. 5. Take the infant to a different room or outside to distract the infant.
A community health nurse determines that it is the right time to teach a family about health promotion activities when they say which of the following?
A) "Is there a place we can go for the medicine?" B) "It's time we do something about eating right." C) "When are you coming back to visit?" D) "Our grandchildren visit every summer."
The elderly spouse of a female Alzheimer's client states that his wife seems to wander aimlessly from room to room looking for things in incorrect places, such as kitchen utensils in the bedroom and laundry detergent in the kitchen
He asks the nurse for suggestions of what he can do to help her. What is the nurse's best response? a. "Keep rooms well lit." b. "Keep the home environment simple and user-friendly for her." c. "Have clocks and calendars with large letters in several rooms of the house." d. "Place large signs on doors or entryways that identify the room."
The client with manifestations of a respiratory infection is suspected of having SARS. In addition to standard precautions, what other infection control precautions should the nurse use until the diagnosis is certain?
A. Airborne precautions B. Droplet precautions C. Airborne precautions and contact precautions D. Droplet precautions and contact precautions