Which question will the nurse ask when assessing the patient's environment for mobility/fall prevention?
1) Does the patient use assistive devices correctly?
2) Are there working smoke detectors in the home?
3) Is there a fire extinguisher in the home?
4) Is there an escape plan in case of a fire?
ANS: 1
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The nurse is aware that when a patient complains of pain in the epigastric region, the source of the pain is most likely to be a disorder involving the:
a. gallbladder. b. transverse colon. c. stomach. d. appendix.
The procedure for collecting a sterile urine specimen via a catheter port includes clamping the Foley catheter tubing below the catheter port. How long will the clamp remain in place?
a. 5 minutes b. 10 minutes c. 20 minutes d. 30 minutes
Which of the following describes the life-threatening condition that is characterized by a rapid shift of fluid from the plasma
into the pulmonary interstitial tissue and the alveoli and that can occur as a result of severe left ventricular failure? a. pneumothorax c. pulmonary edema b. pulmonary hypertension d. pulmonary embolism
A client with paralysis who has been cared for at home for 5 years has just been admitted. A nurse finds a wound over his left trochanter that is about 4 inches in diameter and exposes the bone. How should the nurse document this finding?
A. Stage I pressure ulcer B. Stage II pressure ulcer C. Stage III pressure ulcer D. Stage IV pressure ulcer