The daughter of an older patient says to a nurse, "I am so concerned that my dad is still driving. He is dangerous! He has had a couple of accidents and I am worried that he is going to kill him-self or, worse, somebody else. What can I do?"
The nurse recommends which of the following involved type action strategies for driving cessa-tion? (Select all that apply.)
a. Report the person to the division of motor vehicles for license suspension.
b. Hold a family meeting with the person to discuss the situation and come to a mutual agreement of the problem.
c. Arrange for alternate transportation for the person.
d. Confiscate the keys to the car.
e. Ask the patient's physician to write a pre-scription for the person to stop driving.
ANS: B, C
Options B and C are examples of the involved type of action strategies for driving cessation. Op-tions A, D, and E are all examples of the imposed type of action strategies for driving cessation.
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A client has been placed on 6 L of humidified oxygen via nasal cannula. Which action by the nurse is most appropriate?
a. Drain condensation back into the humidifier, maintaining a closed system. b. Keep the water sterile by draining it from the water trap back into the humidifier. c. Turn down the humidity when condensation begins to collect in the tubing. d. Remove condensation in the tubing by disconnecting and emptying it appropriately.
The client tentatively diagnosed with a borderline personality is admitted to the psychiatric unit for control of symptoms. Based on a thorough understanding of personality disorders, the nurse would select which nursing diagnosis as the priority?
1. Ineffective coping 2. Chronic low self-esteem 3. Risk for self-mutilation 4. Social isolation
Which statement by a patient indicates additional teaching is required about the medication warfarin?
a. "I will continue my diabetic diet and restrict sugar." b. "I will increase the intake of green, leafy vegetables for a more healthful diet." c. "I will restrict the intake of foods high in vitamin C." d. "I will increase the amount of protein in my diet to protect my kidneys."
A nurse notes which finding as normal during cardiovascular assessment of an adult client?
a. Visible, consistent pulsations of the jugular vein b. Pink nail beds with a 90-degree angle at the base c. Capillary refill of the toes greater than 5 seconds d. Bruits heard on auscultation of the carotid arteries