While visualizing the patient's eyes, the nurse notes a red reflex. This indicates:
A) Light is able to bounce off the retina.
B) The arteries are not constricted.
C) The arteries are constricted.
D) Color vision is intact.
A
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Which interventions should the nurse implement to prevent complications of immobility for a child in skeletal traction? Select all that apply
a. Reposition the child every 2 hours. b. Avoid use of an egg-crate or sheepskin mattress. c. Limit fluid intake. d. Administer stool softeners as prescribed. e. Encourage coughing and deep breathing.
A patient with moderate dementia has been admitted to a long-term care facility. To address the patient's need to be engaged in purposeful activity, the nurse arranges for the patient to
a. fold some of the unit's freshly washed washcloths and towels each afternoon. b. help decide what television programs will be on in the dayroom. c. be responsible for changing the day ca-lendar each morning. d. remind other diabetic patients when it is time for their finger sticks.
During an interview, tears appear in the patient's eyes and his voice becomes shaky. Initially, you should:
a. ask him if he would like some time alone. b. offer a tissue and let him know it is all right to cry. c. explain to the patient that you will be able to help him more if he can control his emotions. d. ask the patient what he is upset about.
The nurse is planning a therapeutic communication session with a patient. For which reason should the nurse consider using a process recording?
1. It records the nurse-patient interaction and provides a guideline for therapeutic care. 2. It allows the patient to hear what the nurse stated in the nurse-patient interaction. 3. It allows the nurse to hear what the patient heard in the nurse-patient interaction. 4. It will be useful to reflect on and evaluate the dynamics of a specific interaction and to provide a sample of interaction for consideration in supervision or consultation with others.