A nurse is having difficulty eliciting a patellar reflex. Which of the following would be most appropriate for the nurse to have the patient do?
A) Lock the fingers together and pull against each other
B) Clench his jaw tightly
C) Squeeze a thigh with the opposite hand
D) Stretch the arms overhead
A
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A nurse is uncomfortable with a patient's comments, which are sexual in nature. Which actions by the nurse are most appropriate? (Select all that apply.)
a. Tell the patient to stop making sexual comments. b. Try joking with the patient to establish rapport. c. Tell the patient you are leaving and will return in a few minutes. d. Inform the patient he/she can be sued for this behavior. e. Explain to the patient how you feel about the comments.
The nurse is caring for a patient on t-PA (tissue plasminogen activation) administration. The most common side effect of this infusion is:
A) Bleeding B) Hypertension C) Migraine headache D) Flaccid paralysis
What is the best way for the nurse to determine if a client is experiencing dyspnea?
A) Observe the client's breathing without the client's knowledge B) Evaluate pulmonary function test results C) Send an arterial blood gas sample to the laboratory D) Obtain subjective data from the client
The nurse preparing IV calcium chloride for a client with hypocalcemia should administer the drug in
a. 0.9% normal saline using a 22-gauge IV catheter. b. 3% normal saline using an 18-gauge IV catheter. c. 5% dextrose in water using a 23-gauge IV catheter. d. Ringer's solution using a 20-gauge IV catheter.