The nurse is caring for a child with disseminated intravascular coagulation (DIC).Which is a priority intervention for this child?
A) Frequent ambulation
B) Maintenance of skin integrity
C) Preparation for radiograph procedures
D) Monitoring of fluid restriction
Answer: B
Impairment of skin integrity can lead to bleeding in DIC. The child with DIC should be placed on bed rest. Fluids need to be monitored but will not be restricted. DIC is not diagnosed with radiograph examination but by serum lab studies.
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The nurse is caring for a patient who recently received a kidney transplant. Which of the following would most likely put the patient at risk for organ rejection?
a. Cytotoxic lymphocytes have been activated by the anesthetic used during sur-gery. b. The sequence of amino acids in the major histocompatibility complex molecules differs from that in the donor. c. An allergic response occurs to the natural immunosuppressants the body produces. d. The immune system cannot activate against foreign antigens after an organ is transplanted.
The nurse is taking care of a client who states that he ignores the urge to defecate when he is at work. Which of the following responses by the nurse would explain why this practice should be changed?
1. "If you continue to ignore the urge to defecate, the urge is ultimately lost.". 2. "It is better to suppress the urge than to suffer embarrassment at work.". 3. "This is a common practice, and it will strengthen the reflex later.". 4. "You will get the urge later; don't worry.".
Ordered: An anticholinergic, Scopolamine 300 mcg IV stat for a child with nausea and vomiting SDR: 6 mcg per kg per dose up to a maximum of 0.3 mg per dose. May repeat every 6-8 hr. The child's weight is 40 kg
Dilute with an equal volume of sterile water for injection (SWI) and administer by direct IV in-jection over 2 minutes using the syringe calibrations shown. a. SDR for this child: b. Safe to give or hold and contact prescriber promptly? c. Total amount of diluted medication in mL to be administered: d. Total minutes to administer if applicable: e. mL per min to be administered: f. Total seconds to administer medication: g. Total seconds per calibration to administer:
A Latino American man refuses to acknowledge responsibility for hitting his wife, stating instead, "It's the man's job to keep his wife in line." Which cultural belief may be associated with this client's behavior?
A. Traditional Latino American families are male dominated with clear male–female role distinctions. B. Religious tenets of Latino American culture support the use of violence within a marriage. C. Latino American families are female dominated and the mother possesses ultimate authority. D. Marriage dynamics are controlled by dominant females in Latin American families.