The nurse is planning care for the client who presents with frequent reports of multiple physical complaints
Given knowledge of the leading causes of mental disability, the nurse should plan to include further data collection in which of the following priority areas? 1. Relationships with others
2. History of family violence
3. Alcohol usage
4. Clarity of thought processes
3
Rationale: There is high incidence of a mental disorder in clients with physical illness. Of the five mental disorders listed among the top 10 causes of mental disability worldwide, alcohol use ranks number four. Clarity of thought processes would elicit data in regard to schizophrenia which is further down the list of leading causes. History of family violence and relationships with others are not specific to the current situation and not directly diagnostic for the other top 10 causes of mental disability.
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An emergency room nurse assesses a client who has been raped. With which health care team member should the nurse collaborate when planning this client's care?
a. Emergency medicine physician b. Case manager c. Forensic nurse examiner d. Psychiatric crisis nurse
Persons with normal age-related sensory changes are likely to have the most difficulty distin-guishing which of the following?
a. Spoken pairs of phrases like "she's praised" and "fees raised" b. Orange towel hanging on a beige wall c. "Go" and "to" in lowercase letters in fine print d. Spoken word pairs like "cupful" and "capful"
During a shift assessment, the nurse is assessing the patient's point of maximum impulse (PMI). Where will the nurse best palpate and auscultate the PMI?
A) Left midclavicular line of the chest wall at the seventh intercostal space B) Left midclavicular line of the chest wall at the fifth intercostal space C) Right midclavicular line of the chest wall at the seventh intercostal space D) Right midclavicular line of the chest wall at the fifth intercostal space
Which of the following would new BSN graduates do if they wanted to develop an evidence-based practice?
a. Review literature related to the types of patients they see each day. b. Subscribe to a specialty nursing journal that describes theoretical-based clinical concepts. c. Submit a grant proposal to try a new method of wound dressing. d. Write a report in which practices are evidence based on their unit.