The nurse is providing care to several clients on a medical-surgical unit. Which clients would benefit from the application of heat? Select all that apply
1. Client with muscle spasms in the lower back
2. Client with traumatic injury and bleeding
3. Client with joint contracture
4. Client in pain
5. Client with inflammation
Correct Answer: 1,3,4,5
Clients with traumatic injury causing bleeding should apply ice to vasoconstrict the vessels and reduce the blood loss. All of the other clients would benefit from the application of heat.
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While giving an end-of-shift report at 1915, a nurse realizes that a client's physical therapy session that occurred at 1030 was not documented. Which of the following is the correct method for adding this information to the client record?
a. Ask the oncoming nurse to make the notation for you. b. Date and time the entry for 1915; then write "Late Entry (date-1030)" before making the addition. c. Do not add the information to the chart, but complete an incident report. d. Do nothing, since the physical therapist documented the session in the multidisciplinary progress notes.
A patient in whom cancer has just been diagnosed tells the nurse, "Just get out of here and leave me alone! Let me suffer alone. God is punishing me." The nurse determines that the most appropriate nursing diagnosis for this patient is
a. risk for loneliness. b. powerlessness. c. dysfunctional grieving. d. spiritual distress.
An impact of health care cost-containment measures on nursing has been
a. adding more registered nurses to the skill mix of the nursing team. b. the concern about the assurance of quality care. c. large annual salary increases for nurses. d. development of standards of nursing practice
A 68-year-old client has a long history of poor eating habits and low activity levels. The client now has a diagnosis of type 2 diabetes mellitus. Which of the following nursing interventions should be the priority?
A) Adherence to diabetes screen protocols B) Education about the role that his lifestyle has played in his diagnosis C) Maintenance of function and activities of daily livings D) Self-care measures to aid in the management of his disease