A patient has been on bedrest following a motor vehicle accident. The nurse notes on assessment that the patient's left lower extremity has edema and is warm to the touch. The patient reports the calf of the left leg is slightly painful. The nurse suspects that this assessment may indicate which disorder?
a. Raynaud's syndrome
b. Cellulitis
c. Aneurysm
d. Venous thromboembolism
Answer: d. Venous thromboembolism
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A nurse has been working with a patient for the entire shift. Which action by the nurse is unacceptable?
a. Sharing a personal mobile phone number b. Touching the patient's hand during a painful procedure c. Standing 6 feet away from the patient when conversing d. Using the SBAR method of hand-off communication
A mother tells the nurse at an annual well child checkup that her 6-year-old son occasionally "wets himself". Which response by the nurse is appropriate?
1) Explain that occasional wetting is normal in children of this age 2) Tell the mother to restrict her child's activities to avoid wetting 3) Suggest "time-out" to reinforce the importance of staying dry 4) Inform the mother that medication is commonly used to control wetting
A thorough understanding of how information is currently collected and processed is the starting point in performing a needs assessment. This is also known as which of the following?
1. Assessing internal environment 2. Assessing external environment 3. Planning for the change process 4. Implementing the new system
A child has just returned from surgery for repair of a fractured femur. The child has a long-leg cast on. The toes on the leg with the cast are edematous, but they have color, sensitivity, and movement
What action should the nurse take? a. Call the health care provider to report the edema. b. Elevate the foot and leg on pillows. c. Apply a warm moist pack to the foot. d. Encourage movement of toes.