In planning care for the patient who is on a protocol of bleomycin, an antitumor antibiotic, the nurse will add to the care plan an intervention to:
a. assess hearing acuity.
b. measure urinary output.
c. weigh daily to assess fluid retention.
d. monitor cardiac arrhythmias.
D
Bleomycin is cardiotoxic and can cause cardiac arrhythmias; therefore, this would be the highest priority intervention. Chemotherapies that are ototoxic would warrant a hearing test; urinary output and fluid retention should be assessed with most chemotherapy drugs, and especially for those that are nephrotoxic.
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A client has a terminal diagnosis and is crying while holding a rosary. Which of the following would be the MOST appropriate nursing intervention?
a. Notify the family and the client clergy of the change in the client. b. Provide distractive activities. c. Administer antianxiety medication as ordered by physician. d. Provide quiet, uninterrupted time.
The nurse is planning to teach a class about dental care to a group of expectant women. The nurse should teach that dental hygiene should begin:
1. At birth. 2. When the first tooth erupts. 3. When the child can hold a toothbrush. 4. When the child starts solid food.
The nurse is preparing to provide care to a group of clients. Which specific areas should the nurse focus in order to prioritize the clients' care needs?
Select all that apply. A) Asking if any clients have complex issues B) Noting number of licensed staff assigned for the shift C) Noting time when the attending physicians make rounds D) Identifying clients with specific medication times E) Noting which clients have particular safety needs
A patient is being started on a buld-forming laxative for constipation. What is the best teaching by the nurse for this patient?
a. Be close to a restroom immediately after taking this medication. b. Reduce fluid intake after mixing this medication in milk only. c. Take with a full cup of water and increase daily fluid intake. d. Notify the physician immediately if bowel movements are not daily.