The nurse is caring for a patient with bacterial meningitis. What interventions should the nurse include in the plan of care?
a. Maintain a quiet environment with mi-nimal stimulation.
b. Provide all care using sterile technique.
c. Limit intake of oral fluids.
d. Provide magazines and other activities to reduce daytime naps.
A
The environment is kept quiet with minimal stimulation to reduce the possibility of seizure. The care is done with general precautions. Fluid intake is encouraged, as are daytime naps to preserve energy.
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The nurse assigned to care for a patient with diabetic ketoacidosis (DKA) is aware that this is a life-threatening condition that results in:
1. the inability of carbohydrates, fats, and proteins to be metabolized. 2. the storage of glycogen, so that there is a severe shortage of glucose in the blood-stream. 3. dangerously elevated pH and bicarbonate levels in the blood. 4. severe hypoglycemia, which can result in coma and convulsions.
The school nurse observes an unkempt child dressed in inappropriate clothing who repeatedly asks for food. The nurse is concerned about which problem?
a. Physical abuse b. Physical neglect c. Emotional abuse d. Sexual abuse
On palpation the nurse determines that the patient's left thyroid lobe is larger than the right thyroid lobe. What is the nurse's most appropriate action at this time?
a. Refer the patient to the health care provider for further evaluation. b. Document that the patient's thyroid is normal on palpation. c. Palpate the left thyroid lobe again using very firm pressure. d. Ask the patient to flex the chin toward his chest and palpate again.
MC A surgical checklist includes all of the following information except
A. Allergies. B. History and physical. C. Physician's name. D. Identification band checked with chart.