A client has a small-bore feeding tube (Dobhoff tube) inserted for continuous enteral feedings while recovering from a traumatic brain injury. What actions should the nurse include in the client's care? (Select all that apply.)
a. Assess tube placement per agency policy.
b. Keep the head of the bed elevated at least 30 degrees.
c. Listen to lung sounds at least every 4 hours.
d. Run continuous feedings on a feeding pump.
e. Use blue dye to determine proper placement.
ANS: A, B, C, D
All of these options are important for client safety when continuous enteral feedings are in use. Blue dye is not used because it can cause lung injury if aspirated.
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The nurse is performing a cultural assessment on a patient. What does the nurse know about cultural assessments?
a. They are intrusive and time consuming. b. They are not dependent on a trusting relationship. c. They are rarely plagued by miscommunication. d. They are based in similarities of behavior.
A patient with a history of primary hypertension has undergone echocardiography after being referred to a specialist for blood pressure management. The patient's echocardiogram revealed ventricular hypertrophy and a decreased ejection fraction
The nurse who is providing care for this patient should recognize that these findings are characteristic of what valvular disorder? A) Mitral valve regurgitation B) Mitral valve stenosis C) Aortic stenosis (AS) D) Tricuspid regurgitation
The nurse is caring for a client with long-standing hypertension. As a client advocate, which instruction is most helpful in preventing further complications?
A) Maintain a healthy diet of fruits and vegetables. B) Focus on exercise at least twice a week. C) Obtain a regular appointment with eye doctor. D) Avoid use of caffeinated beverages.
Select the complex fraction that is the correct answer. ½ ÷ 200 =
1. 1/100 2. 200 3. 1/400 4. 100