Following a motorcycle accident, a 17-year-old boy is brought to the emergency department. He has sustained multiple traumas, including a head injury. What physical assessment findings related to the ear should be reported by the nurse immediately?
A) The malleus can be visualized during otoscopic examination.
B) The tympanic membrane is pearly gray.
C) Tenderness is reported by the patient when the mastoid area is palpated.
D) Clear, watery fluid is draining from the ear.
D
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The nurse is demonstrating cultural sensitivity in performing perineal care when he/she does the following: (Select all that apply.)
a. The male nurse delegates perineal care of a female patient to the female UAP. b. The male nurse asks a female patient if she would prefer a female to perform care. c. The nurse approaches the care in a sensitive, professional manner. d. The nurse assesses cultural preferences of the patient prior to care.
A novice nurse has just completed orientation in the pediatric intensive care unit (PICU). The nurse is striving to attain the required skill level to care for children returning from open-heart surgery. The mentor want to assist the novice nurse in reach
Which assignment would allow this to occur? A) A pediatric client who is recovering from open heart surgery and requires discharge teaching. B) A critically ill pediatric client who is recovering from a major abdominal surgery. C) A pediatric client who is recovering from heart surgery on the step down unit. D) A pediatric client who requires emergency resuscitations.
Which of the following clinical assessment findings is most likely seen in a client experiencing hypokalemia as a result of the misuse of potassium-wasting diuretics?
1. Dry, sticky tongue 2. Increased anxiety 3. Nausea and vomiting 4. Decreased bowel sounds
Which should the nurse include in a teaching session for the parents of an infant who will be placed in a Pavlik harness for the treatment of congenital developmental dysplasia?
1. Apply lotion or powder to minimize skin irritation. 2. Check at least 2 or 3 times a day for red areas under the straps. 3. Put clothing over the harness for maximum effectiveness of the device. 4. Place a diaper over the harness, preferably using a thin, superabsorbent, disposable diaper.