An older adult female client is being seen in the physician's office for a possible fractured tibia. The nurse asks how that happened, and the client begins a long discourse about how much it snowed last night,
whom she was with, what she was wearing, and how much the taxi cost. The nurse recognizes this response as indications of:
a. Blocking.
b. Flight of ideas
c. Neologisms.
d. Confabulation.
ANS: D
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The physician has ordered a medication that is contraindicated for the patient. The nurse, after discussion with the physician and the pharmacy, refuses to administer the medication. Upon what legal principle does the nurse base this refusal?
A) Respondeat superior B) Captain of the ship C) Corporate liability D) Rule of personal liability
The nurse is asked by the spouse of a patient seeking crisis intervention to give an example of an adventitious crisis. The nurse should mention:
a. the death of a child from sudden infant death syndrome. b. being fired from one's job because of company downsizing. c. the retirement of a 64-year-old man after 30 years' service. d. a riot at a rock concert that results in multiple casualties.
The nurse instructs a married couple on the importance of treatment for a chlamydia infection. Which statements indicate that teaching was effective? Select all that apply
A) "He could get an infection in the tube that carries the urine out." B) "She could have severe vaginal itching." C) "It could cause us to develop rashes." D) "She could develop a worse infection of the uterus and tubes." E) "She could become pregnant."
A nurse is caring for a patient with asthma with a nursing diagnosis of "Impaired gas exchange, related to air trapping." Which intervention is the most appropriate to add to the nursing care plan?
a. Provide postural drainage. b. Administer oxygen (O2) at 8 L/min. c. Position the patient flat in bed with small pillow. d. Increase fluid intake.