The nurse is trying to determine the type of mental status changes a client is demonstrating. Which condition is of the shortest duration by definition?
a. Acute confusion
b. Dementia
c. Alzheimer's disease
d. Depression
ANS: A
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The mother of a 7-year-old boy asked the nurse what factors tended to increase self-esteem in boys. Which of the following is the nurse's best response?
a. Positive family communication supporting the child's self-worth. b. It does not really matter because self-esteem varies widely throughout life. c. Avoid situational crises because they lead to permanent changes in self-esteem. d. Let the child know that it is OK to be incompetent.
The nurse assesses the frostbite on the victim's hands and feet to be second-degree frostbite because the skin is:
a. reddened and has hard white plaques. b. waxy and has sensory deficits. c. reddened and has blisters filled with milky fluid. d. waxy and has blisters filled with blood.
The nurse assesses the postpartum client to have moderate lochia rubra with clots. Which nursing intervention would be appropriate?
1. Assess fundus and bladder status. 2. Catheterize the client. 3. Administer Methergine IM per order. 4. Contact the physician immediately.
Meningitis is assessed by which of the following after blood tests and a physical assessment are completed?
1. Lumbar puncture 2. Urine tests 3. Kernig's sign and Brudzinski's sign 4. Physical examination