An 11-year-old girl is diagnosed with idiopathic thrombocytopenic purpura (ITP). The parental statement that helps the nurse evaluate the teaching as successful is:
1. "Our daughter can still be involved in gymnastics."
2. "When our daughter's hemoglobin falls below 3.5, she'll need blood."
3. "Our daughter will need genetic counsel-ing before she marries."
4. "Our daughter should avoid drugs con-taining sulfonamides."
4
Drugs known to induce ITP include sulfonamides.
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A nurse is caring for a client with terminal cancer. The client asks the nurse, "What is the difference between palliative and hospice care?" What is the best response by the nurse?
A) "There is no difference between the two." B) "In palliative care, you must have a terminal illness and have less than 6 months to live. In hospice care you can be in your last stage of illness." C) "Palliative care is focused on attempting to achieve the best quality of life for a client with a serious illness. You may be in any stage of the disease. Hospice care is care and support for a client with less than 6 months to live focused so that the client may live as fully and comfortably as possible." D) "Palliative care can only take place in your home. Hospice care can take place in any care setting."
A nurse caring for a 9-year-old notices some swelling in the child's ankles. The nurse presses against the ankle bone for five seconds,then releases the pressure and notices a markedly slow disappearance of the indentation
Due to these physical findings,the nurse would be most concerned with assessing 1. skin integrity,especially in the lowerextremities. 2. urine output. 3. level of consciousness. 4. range of motion and ankle mobility.
The main goal set forth by the nurse for a patient experiencing PTSD is to:
A) Encourage the patient to describe the situation that led to the PTSD B) Tell the patient that the danger is all over C) Have the patient tell you what he or she should expect when he or she is about to have a flashback D) Ensure that the patient gets 6 to 8 hours of uninterrupted sleep nightly
Which of the following best reflects accurate documentation of a risk nursing diagnosis?
A) Risk for fatigue related to increased job demands as manifested by feelings of exhaustion and frequent naps B) Risk for infection as manifested by lack of client knowledge of wound care C) Risk for violence related to history of overt, aggressive acts D) Risk for altered respiratory function related to environmental allergens as manifested by asthma