The nurse is caring for a patient who has a chest tube. Attached to the top of the patient's bed are two shodded hemostats. In which situations would these be used? (Select all that apply.)
a. To assess an air leak
b. To quickly empty or change disposable systems
c. To quickly seal off the lungs if the system becomes disconnected
d. To assess whether the patient is ready to have the chest tube removed
A, B, D
Chest tubes are clamped only under the following specific circumstances, per health care provider order or nursing policy and procedure: to assess air leak, to quickly empty or change disposable systems, or to assess whether the patient is ready to have the chest tube removed (which is done by a health care provider's order). Clamping an open system could lead to a tension pneumothorax.
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After teaching a group of nursing students issues and problems commonly associated with antiparkinson drug therapy, the instructor determines that the teaching was successful when the students identify which nursing diagnosis as common?
Select all that apply. A) Risk for Injury B) Risk for Infection C) Diarrhea D) Impaired Physical Mobility E) Imbalanced Nutrition: More Than Body Requirements
The implementation team is concerned about feature creep. Which best describes this occurrence?
A) When an additional feature must be added to the system, the implementation committee approves the change after investigating its cost. B) The system is totally customized for an individual organization to reflect the current workflow. C) Staff nurses expect the new system will cut their workload relating to documentation in half. D) The emergency department and intensive care unit supervisors meet and come up with a list of new features to be added to the system.
A diabetic pt is scheduled to have a blood glucose test the next morning. What does the nurse tell the pt to do before coming in for the test?
a. eat the usual diet but have nothing after midnight b. take the usual oral hypoglycemic tablet in the morning c. eat a clear liquid breakfast in the morning d. follow the usual diet and medication regimen
The patient is found to have impacted cerumen in his ear canal. The nurse most likely will:
a. instill 1 to 2 drops of mineral oil. b. instill the irrigation under pressure. c. occlude the ear canal when irrigating. d. straighten the ear canal.