The nurse is conducting an abdominal assessment of a patient who is postoperative day 1 following an open cholecystectomy
During auscultation of the patient's abdomen, the nurse has noted that clicks and gurgles are audible approximately every 10 seconds. How should the nurse follow up this assessment finding?
A) The nurse should administer a p.r.n. stool softener.
B) The nurse should contact the patient's care provider.
C) The nurse should assess the patient for paralytic ileus.
D) The nurse should document normoactive bowel sounds.
D
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A nurse is assessing an 11-month-old infant, and notes that the infant's height and weight are at the 5th percentile on the growth chart
Family history reveals that the two siblings are at the 50th percentile for height and at the 75th percentile for weight. Psychosocial history reveals that the parents are separated and are planning to divorce. Which of these nursing diagnoses takes priority? 1. Alteration in growth pattern related to parental anxiety 2. Alteration in growth pattern secondary to familial short stature 3. Nutritional intake: excessive secondary to maternal feeding patterns 4. At risk for constitutional growth delay as related to decreased appetite
A nurse is discussing storage of breast milk with a mother whose infant is preterm and in the special care unit. What statement would indicate that the mother needs additional teaching?
1. "I can store my breast milk in the refrigerator for 3 months.". 2. "I can store my breast milk in the freezer for 3 months.". 3. "I can store my breast milk at room temperature for 8 hours.". 4. "I can store my breast milk in the refrigerator for 3 to 5 days.".
A nurse records the number of clients seen daily as well as the mode of transportation and miles driven. Which of the following types of records is being used?
a. Clinical record b. Provider service record c. Financial record d. Central index system
A patient has a new prescription for enfuvirtide. Which information would the nurse include in the teaching plan?
1. The importance of injecting the drug into the same site daily 2. How to reconstitute and self-administer a subQ injection 3. The importance of taking this drug with high doses of vitamin E 4. Drug interactions that are likely between enfuvirtide and other antiretroviral drugs