When checking the patient's back, the nurse pushes her thumb into the patient's sacrum. An indentation remains. The nurse charts that the patient has
a. sacral compromise. c. pitting edema.
b. delayed skin turgor. d. dehydration.
C
Pitting edema occurs when an impression is left in the tissue when the thumb is removed. The dependent tissues within the legs and sacrum are particularly susceptible. Edema may be dependent, unilateral, or bilateral and pitting or nonpitting.
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A client is using Depo-Provera as her method of birth control. Which finding warrants immediate intervention?
a. Mid-cycle bleeding b. Nausea c. Temperature of 100° F d. Irregular periods
A child has recently been diagnosed with aplastic anemia.Support for the family should include
1. referrals to support groups andsocial services. 2. short-term support. 3. genetic counseling. 4. nutrition counseling.
A female client on an inpatient unit enters the day area for visiting hours dressed in a see-through blouse and wearing no undergarments. Which intervention should be a nurse's first priority?
A. Contact the client's psychiatrist. B. Avoid addressing her attention-seeking behavior. C. Lead the client back to her room and assist her to choose appropriate clothing. D. Restrict client to room until visiting hours are over.
The nurse is planning a presentation on crisis intervention to faculty and staff at a local high school. What information should the nurse include? (Select all that apply.)
1. How to identify colleagues who are approaching exhaustion 2. How to conduct a psychological debriefing 3. How to reinforce basic coping skills with students 4. How to recognize common cultural responses to crisis 5. How to encourage social connectivity among other faculty and staff