Which nursing action could the nurse delegate to unlicensed assistive personnel (UAP) when caring for a patient who is using a fentanyl (Duragesic) patch and a heating pad for treatment of chronic back pain?
a. Check the skin under the heating pad.
b. Take the respiratory rate every 2 hours.
c. Monitor sedation using the sedation assessment scale.
d. Ask the patient about whether pain control is effective.
ANS: B
Obtaining the respiratory rate is included in UAP education and scope of practice. Assessment for sedation, pain control, and skin integrity requires more education and scope of practice.
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What would be the most appropriate nursing response to a woman who says, "My sister had a child with Tay-Sachs disease, and I want to know if I could have a child with this condition"?
a. "The disease is rare. It is unlikely that you would have a child with Tay-Sachs disease." b. "A screening test can be done to determine if you are a carrier of the gene." c. "The gene for Tay-Sachs disease is transmitted by the father." d. "The cause of Tay-Sachs disease is thought to be an autoimmune response to a virus."
The prevalence of obesity in the United States has risen dramatically in both adults and children. The increase in the number of overweight children is addressed in Healthy People 2020
Strategies designed to approach this issue include (select all that apply) a. Decreased calcium and iron intake b. Increased fiber and whole grain intake c. Decreased use of sugar and sodium d. Increase fruit and vegetable intake e. Decrease the use of solid fats
Which statement made by the client after a corneal transplant indicates the need for further teaching?
A. "I will wear an eye shield at night for at least 1 month." B. "I will avoid bending at the waist or straining when moving my bowels." C. "Any fluid coming from my eye is a result of excessive tears stimulated by the surgery." D. "Even though the cornea does not have blood vessels, rejection of the new cornea is still possible."
A client admitted with chest pain is being evaluated for a myocardial infarction (MI). Which of the following comments made by the client would best indicate the pain is angina rather than an MI?
A) "The pain went away when I took a nap." B) "I took nitroglycerin but the pain was not relieved." C) "I was very short of breath and sweating with the pain." D) "The pain started when I was watching television."