The nurse is developing the care plan for a laryngectomy patient. Which patient need will be of the highest priority for the nurse to address?
a. A method of pain control
b. Family support
c. A method of communication
d. The need for long-term care
C
Pain control and family support are important, but the need of a method of communication is pa-ramount for a new tracheostomy patient to allay anxiety, ensure accurate communication between the patient and the nurse, and make the patient comfortable that nursing staff are attentive. The need for long-term care may not be necessary.
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A client is proud of a recent breakthrough in his ability to control his anger when another client had criticized his behavior. The nurse shakes the client's hand and praises him on his accomplishment
How should this nurse's behavior be interpreted? 1. This gesture is inappropriate because it could seem condescending to the client. 2. This gesture is appropriately timed and suitable in this situation. 3. The use of touch is inappropriate with any client no matter the reason. 4. The use of touch may be perceived as a sexual overture in this situation.
Potassium phosphate IV has been prescribed for a patient who has hypophosphatemia. Which nursing interventions are indicated when administering this medication?
1. Dilute the dose in 100 mL of normal saline (NS) and administer over 20 minutes. 2. Monitor the patient for respiratory distress. 3. Monitor for the development of hypotension. 4. Ensure that pharmacy has mixed the medication with a local anesthetic.
A client has recently undergone an anterior colporrhaphy. Which is the most important discharge instruction that the nurse can provide?
a. "Avoid sexual intercourse for 2 weeks." b. "Call us for fever and pain that does not improve." c. "Sutures will need to be removed in 2 weeks." d. "An ice pack on your incision will help the pain."
The client with type 2 diabetes is prescribed to take the antidiabetic agent nateglinide (Starlix). Which statements made by the client indicates correct understanding of this thera-py?
A. "I'll take this medicine with my meals." B. "I'll take this medicine 15 minutes before I eat." C. "I'll take this medicine just before I go to bed." D. "I'll take this medicine as soon as I wake up in the morning."