The nurse is evaluating care provided to a client with a mood disorder. Which observations indicate that interventions to improve cognition were effective? (Select all that apply.)
1. Hallucinates at bedtime
2. Plans self-care activities
3. Engages in reality-based thinking
4. States efforts to cope with behavior
5. Oriented to person, place, time, and situation
Answer: 2, 3, 4, 5
1. Hallucinations indicate that actions to improve cognition were not effective.
2. Planning self-care activities indicates that actions to improve cognition were effective.
3. Engaging in reality-based thinking indicates that actions to improve cognition were effective.
4. Stating efforts to cope with behavior indicates that actions to improve cognition were effective.
5. Being oriented to person, place, time and situation indicates that actions to improve cognition were effective.
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A patient has been admitted to the critical care unit from the subacute medical unit because his signs and symptoms of liver failure have become more pronounced over the past 24 hours
The critical care nurse who is planning this patient's care should prioritize which of the following nursing diagnoses? A) Risk for bleeding related to complications of liver failure B) Knowledge deficit related to the causes of liver failure C) Bowel incontinence related to treatments for liver failure D) Risk for impaired gas exchange related to complications of liver failure
On the fourth postoperative day, the client has a sudden coughing episode and tells the nurse that "something popped" in the abdominal incision. Upon inspection, the nurse finds that evisceration has occurred
What nursing action should be taken first? A) Notify the client's surgeon. B) Position the client in bed with knees bent. C) Cover the area with a large saline-soaked dressing. D) Pack the wound with nonadherent gauze.
Which hematoma occurs along the temporal cranial wall and results from tears in the middle meningeal artery?
a. Epidural hematoma b. Subdural hematoma c. Subarachnoid hematoma d. Intraparenchymal hemorrhage
Which prescriptions does the nurse anticipate to be included in the goal to reduce the post-MI mortality of a client?Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
A. Aspirin B. Beta blockers C. Narcotic analgesics D. ACE inhibitors E. Antidysrhythmics