A patient is admitted after being bitten by a dog and tells the nurse he feels fine except for the bite. The nurse assesses that this patient is functioning within which phase of the general adaptation syndrome?

1. Transaction
2. Resistance
3. Alarm
4. Exhaustion


2
Rationale 1: There is no transaction stage within the general adaptation syndrome.
Rationale 2: In this stage, the body attempts to cope with the stressor by minimizing the stressor's impact as much as possible. The patient's statement is an attempt to return to normal as soon as possible.
Rationale 3: The alarm stage is the first stage of the general adaptation syndrome, when the fight-or-flight response is initiated.
Rationale 4: The exhaustion stage is the final stage, in which the adaptation the body made during the second stage cannot be maintained. This stage occurs only if the stress becomes overwhelming or is not removed.

Nursing

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A nurse is writing a care plan for a patient with a nasogastric tube in place for gastric decompression. What risk nursing diagnosis is the most appropriate component of the care plan?

A) Risk for Excess Fluid Volume Related to Enteral Feedings B) Risk for Impaired Skin Integrity Related to the Presence of NG Tube C) Risk for Unstable Blood Glucose Related to Enteral Feedings D) Risk for Impaired Verbal Communication Related to Presence of NG Tube

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The nursing assistant remarks to the nurse, "The client with amnesia looks together, but when I talk

to her she seems rather vague. What should I be doing for her?" The best reply would be a. "Give her lots of space to test her independence.". b. "Whenever you think she needs direction, use short, simple sentences.". c. "Spend as much time with her as you can and ask questions about her recent life.". d. "Keep her busy and make sure she doesn't take naps during the day.".

Nursing

At 34 weeks' gestation, a normal prenatal client should have a hematocrit of:

a. less than 25% c. 34% to 40% b. 25% to 35% d. more than 40%

Nursing

In the example in which there is a medication error, the hospital policy is to use root-cause analysis to fully evaluate the situation. In the root-cause analysis process, one would expect that:

a. a committee is formed to determine the risk of litigation. b. a committee is formed to determine the punishment for those involved. c. a committee is formed that can reconstruct the events leading to the error. d. a committee is formed that can correct the error and avoid damages.

Nursing