An older adult's perineal skin appears to be dry and thin with mild excoriation. When providing hygiene after a bowel movement, the nurse should
a. Thoroughly scrub the skin with a wash cloth and hypoallergenic soap.
b. Apply a skin protective lotion after perineal care.
c. Tape an occlusive moisture barrier pad to the patient's skin.
d. Massage the skin with deep kneading pressure.
B
Proper skin care and perineal cleaning require that the nurse gently clean the skin and apply a moistening barrier cream. Tape and occlusive dressings can damage skin. Excessive pressure and force are inappropriate and may cause skin breakdown.
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As part of their orientation to a cardiac care unit, a group of recent nursing graduates is receiving a refresher in cardiac physiology from the unit educator
Which of the following teaching points best captures a component of cardiac function? A) "Efficient heart function requires that the ventricles do not retain any blood at the end of the cardiac cycle." B) "Recall that the heart sounds that we listen to as part of our assessments are the sounds of the myocardium contracting." C) "The diastolic phase is characterized by relaxation of ventricles and their filling with blood." D) "Aortic pressure will exceed ventricular pressure during systole."
Which assessment finding could indicate hemorrhage in the postpartum patient?
a. Firm fundus at the midline b. Saturation of two perineal pads in 4 hours c. Elevated blood pressure d. Elevated pulse rate
The wife of a patient who has just died states, "I hate all of you nurses and doctors for letting my husband die." What should the nurse recognize this reaction as according to Martocchio's clus-ters of grief?
a. Shock and disbelief b. Yearning and protest c. Anguish, disorganization, and despair d. Identification in bereavement
Before shaving a man's face with a safety razor, you need to do which of the following?
a. Put on gloves b. Apply a cold washcloth to his face c. Apply lotion on the face d. Dry the face thoroughly