While conducting a comprehensive assessment the client states that she is experiencing a headache due to high blood pressure. How should the nurse corroborate this information?
1. Checking the client's temperature
2. Recording the client's pain score
3. Asking the spouse for confirmation
4. Measuring the blood pressure
Answer: 4
1. The client's temperature will not validate high blood pressure.
2. The nurse validates using objective data. Pain score is a subjective symptom.
3. The spouse cannot corroborate the client's blood pressure.
4. The nurse should measure the client's blood pressure to validate the client's subjective information.
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The osteoporosis patient asks the nurse to explain what a bisphosphonate medication does. The nurse will respond,
A) "This medication helps prevent bone resorption, which will help prevent fractures." B) "These drugs increase your phosphorus levels and thereby help with your calcium levels as well." C) "This medication stimulates your parathyroid gland to increase osteoclastic activity." D) "This medication plays an important role in bone remodeling."
An adult client consumes about 1800 calories per day. How many calories per day should the nurse counsel the client to consume from fats?
a. 200 calories b. 450 calories c. 800 calories d. 1000 calories
The nurse assesses beginning acceptance of the diagnosis of cancer when the patient:
1. begins to act in a cheerful manner. 2. inquires about support groups. 3. cries over loss of health. 4. actively interacts with his or her family.
The nurse is assessing a newborn's circumcision 30 minutes after the procedure. The nurse notes excessive bleeding coming from the circumcised area. Which priority intervention should the nurse implement?
a. Apply pressure to the site. b. Continue to observe for another 30 minutes. c. Apply the diaper tightly over the circumcised area. d. Apply petroleum jelly to the site with a small piece of gauze.