A client is diagnosed with cellulitis. Which of the following will the nurse most likely assess in this client? (Select all that apply.)
1. Heat
2. Redness
3. Swelling
4. Pain
5. Glossy, stretched skin appearance
6. Thirst
1, 2, 3, 4, 5
Cardinal signs of cellulitis include heat, redness, swelling, pain, and a glossy, stretched appearance of the skin. Thirst is not associated with cellulitis.
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An elderly chronically confused client with Alzheimer's disease frequently states that the nursing home is her home to which she has invited people for a party. The most appropriate nursing response to this client's perception is to
a. give detailed explanations about the nursing home. b. "go along" with the client's confused statements. c. provide a lot of sensory stimulation. d. reorient the client as often as necessary.
The client has been ordered to be treated with Robaxin. The client calls the nurse in a panic and reports that his urine is black in color. The nurse's response should be based on the knowledge that this is indicative of a(n) _______ to the medication
a. anaphylactic reaction b. adverse reaction c. subnormal response d. expected response
While visiting the home of an 89-year-old woman out in the country, the nurse learns that her primary care provider's office is one hour's drive away. The client states, "I've just stopped going in for appointments in the past few years
It's just too far for me to drive by myself." This situation exemplifies which of the seven A's of challenges to elders in rural areas? A) Availability B) Accessibility C) Affordability D) Awareness
Which of the following clients would be the most likely candidate to develop respiratory acidosis?
A) A client who has renal disease B) A client who is hyperventilating C) A client who has excessive gastric suctioning D) A client who has emphysema