When the wife asked if the nurse would like a tour of the yard and her beautiful gardens, the nurse agreed immediately. Considering the limited time the nurse had to spend with the family, why did the nurse agree to tour gardens?
A. Accepting the invitation was the polite thing to do.
B. Because the wife was proud of her gardening skills, the nurse did not wish to offend her.
C. Examination of the environment may help identify potential health or safety problems.
D. Touring the grounds was a nice change of pace for the overworked, stressed nurse.
ANS: C
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The nurse is caring for a patient admitted with unstable angina. The laboratory result for the initial troponin I is elevated in this patient. The nurse should recognize what implication of this assessment finding?
A) This is only an accurate indicator of myocardial damage when it reaches its peak in 24 hours. B) Because the patient has a history of unstable angina, this is a poor indicator of myocardial injury. C) This is an accurate indicator of myocardial injury. D) This result indicates muscle injury, but does not specify the source.
An elderly client tells the nurse that she is having difficulty sleeping because she is up all night voiding since she has been told to drink eight glasses of water every day. Which of the following should the nurse assess in this client?
a. Volume of urine output with each episode of voiding b. Ambulatory status c. Appetite d. Time in which the fluids are being ingested
Symptoms of anxiety are MOST commonly treated with which of the following types of medications?
a. tricyclics b. sedatives c. lithium d. benzodiazepines
The nurse is caring for a client who has right-sided paralysis after a CVA (stroke). Which of the following factors would be most likely to result in pressure ulcer formation for this client?
a. Poor nutrition b. Immobility c. Reduced hydration d. Skin secretions