The nurse is preparing to check the respirations of a newborn who was just delivered. The nurse performs the procedure and determines that the respiratory rate is normal if which of the follow-ing is noted?
1. A respiratory rate of 20 breaths/min
2. A respiratory rate of 40 breaths/min
3. A respiratory rate of 70 breaths/min
4. A respiratory rate of 80 breaths/min
2
Rationale: Normal respiratory rate varies from 30 to 60 breaths/min when the infant is not crying. Respirations should be counted for 1 full minute to ensure an accurate measurement because the newborn is a periodic breather. Observing and palpating respirations while the infant is quiet promote accurate data collection.
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A client becomes agitated and restless a few hours after being given a sleeping pill. The nurse recognizes the client is most likely experiencing:
A) an idiosyncratic drug reaction. B) a toxic effect from the medication. C) an allergic reaction to a chemical in the medication. D) a side effect of the medication.
An elderly client was diagnosed with a left cerebral hemorrhage. To meet the needs of the client and family, the nurse will include teaching in which of the following areas? (Select all that apply.)
1. How to use a sign board 2. Transfer techniques 3. Information about impulse control 4. Time adjustment to complete activities 5. Nutrition support
Instructions for the use of a male condom should include that:
a. Condoms offer 100% protection against pregnancy. b. Water-soluble lubricants should be used to reduce the risk of breakage. c. The condom should tightly cover the tip of the penis. d. Natural skin condoms are best for preventing infections.
A patient is concerned about becoming an alcoholic since both parents abuse alcohol. How should the nurse respond to the patient?
A. "You will likely become an alcoholic." B. "Don't worry about that." C. "Why are you concerned about becoming an alcoholic?" D. "There are studies that support a genetic link for developing alcoholism."