The nurse is providing care for a client who experienced an ischemic stroke five days ago. Which of the following diagnoses would the nurse be justified in identifying and documenting in the care of this client? Select all that apply
A) Dysphagia
B) Bowel Incontinence
C) Impaired Swallowing
D) Impaired Physical Mobility
E) Risk for Hemiparesis
Ans: B, C, D
Bowel Incontinence, Impaired Swallowing, and Impaired Physical Mobility are all health problems that can be independently prevented or resolved by nursing practice. Dysphagia and hemiparesis are medical diagnoses.
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The nurse is caring for a woman of Middle Eastern descent on the first postpartum day. Education is provided regarding instruction on use of a sitz bath. What documentation best indicates that the woman has understood the provided instruction?
a. Patient correctly performed return demonstration. b. Patient indicated understanding by nodding head with instruction. c. Patient verbalizes "I understand." d. Family member indicates patient understands procedure.
A patient presents to the emergency department (ED) having an acute asthma attack. An ED physician has ordered a sympathomimetic (epinephrine). The nurse expects what as the therapeutic effect of this drug?
A) Decrease the inflammatory response in the airways B) Reduce the surface tension within the alveoli allowing for gas exchange C) Inhibit the release of histamine and slow-reacting substance of anaphylaxis (SRSA) to prevent the allergic asthmatic response D) Cause dilation of the bronchi with increased rate and depth of respiration
The client is being seen for her first prenatal appointment at 14 weeks' gestation. She is sure of her last menstrual period (LMP). The fundal height is measured at 20 centimeters
Which test would the nurse anticipate that the certified nurse-midwife will order for this client? A. Amniocentesis for fetal genetic anomaly B. Ultrasound to determine the number of fetuses C. Beta hCG to detect the location of the pregnancy D. Maternal serum alpha fetoprotein for Down syndrome
The school nurse is concerned about the lack of nutritional choices available in the food vending machines at the school. Which is the best tool to address this situation?
A) Food-Safe Schools Action Guide B) Health Education Curriculum Analysis Tool C) Improving the Health of Adolescents and Young Adults: A Guide for States and Communities D) Making It Happen!