The nurse is caring for a patient on the medical-surgical unit
The patient states, "I really don't like to talk about my bowel movements, but what is considered a normal bowel movement?" What is the best response by the nurse? Select all that apply.
a. "We usually like to set an acceptable standard of at least one bowel movement per week."
b. "We can say normal frequency is anything from several times a day to once per week. It depends on your normal pattern."
c. "We also consider whether you have to strain with bowel movements, use laxatives, or have to rush to the toilet."
d. "There is no such thing as normal. All people are different, so don't worry about it."
B, C
Part of the confusion about bowel function is that there is a wide range of "normal." The frequency of BMs may range from several times per day to once a week. As long as the person passes stools without excessive urgency (needing to rush to the toilet), with minimal effort and no straining, without blood loss, and without the use of laxative, you can regard bowel function as normal. The best responses by the nurse are therefore the ones that provide the patient with the most information. Although telling a patient there is no such thing as normal and all people are different is not incorrect, it does not provide the patient any information regarding what constitutes "normal" as far as number of BMs, what they should look like, defecation without much straining, and so on. Moreover, that statement advises the patient not to worry about it, which is condescending and negates feelings.
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Organizations are required to follow specific behaviors and actions that provide nurses with the resources they need in order to efficiently delegate. Some of these are listed below. Which is not necessarily correct?
a. Maintain adequate staffing. b. Provide standards for ongoing supervision and periodic licensure/ competency verification and evaluation of all staff. c. Facilitate regular evidence-based reviews of critical standards, policies, procedures, nurses, and nursing diagnosis. d. Consider the need to develop a shared governance model of nursing practice encouraging active participation of all nurses in decision-making and delegation standards.
A client tells the nurse that she has kicked her husband of 20 years out of the house because he "kept having affairs with other women and seeing prostitutes." The nurse suggests that she considers HIV testing because she knows that
A) it is estimated that there are more than 100,000 people in the United States who are HIV-positive but do not know they are infected. B) about half of all new HIV infections in the United States are among individuals over 25 years of age. C) married women are a high risk group for sexually transmitted diseases. D) the highest rates of sexually transmitted diseases are found in the white population.
How much protein should Mr. N receive per day?
While inspecting the tympanic membrane of an older adult, a nurse notices the membrane is more translucent and sclerotic, which contributes to which hearing impairment?
a. Gradual high-frequency hearing loss associated with aging b. Conductive hearing loss c. Difficulty hearing high-pitched sounds such as s and th d. Sensorineural hearing loss