A nurse cares for a client with right-sided heart failure. The client asks, "Why do I need to weigh myself every day?" How should the nurse respond?
a. "Weight is the best indication that you are gaining or losing fluid."
b. "Daily weights will help us make sure that you're eating properly."
c. "The hospital requires that all inpatients be weighed daily."
d. "You need to lose weight to decrease the incidence of heart failure."
ANS: A
Daily weights are needed to document fluid retention or fluid loss. One liter of fluid equals 2.2 pounds. The other responses do not address the importance of monitoring fluid retention or loss.
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135 à· 8.4 = _____
a. 1.8 b. 16.071428 c. l60.71428 d. 1.6
A nurse has been called to the scene where an individual is unconscious after experiencing an airway obstruction. The nurse has consequently initiated chest compressions. This intervention will help the client in what way?
A) Increasing intrathoracic pressure in order to clear the obstruction B) Increasing cardiac output in order to help the client spontaneously clear the obstruction C) Creating temporary pressure on client's vascular system to facilitate airway clearance D) Stimulating the client's vagus nerve to relax the upper airway
The news reported that a train derailment 5 miles away from the clinic spilled a large amount of liquid chlorine that has been vaporized by the atmosphere. An indication that the chlorine gas is an imminent threat to the clinic would be:
a. sighting of a low-lying green cloud. b. smelling "almonds" or "burning feathers." c. sudden nausea. d. skin blistering.
A nurse is caring for an African-American child recently admitted to the hospital. The nurse should be aware of which broad cultural characteristics for this child when planning care (Select all that apply)?
a. Silence may indicate a lack of trust. b. Maintaining constant eye contact may be viewed as aggressive. c. Self-care and folk medicine do not play a role in health care. d. Illness may be seen as the "will of God." e. No importance is attached to nonverbal behavior.