What is an early sign of necrotizing enterocolitis (NEC) in the preterm infant?
a. Temperature instability c. Meconium ileus
b. Reflux d. Abdominal distension
D
In addition to abdominal distension, gastric residuals, vomiting, and bloody stools are early indicators of NEC. Temperature instability, reflux, and meconium ileus are not early manifestations of NEC.
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The ICU postoperative cardiac patient has a pulmonary artery wedge reading of 11 mm Hg. The critical care nurse realizes this indicates
A) hypovolemia. B) hypervolemia. C) a normal pressure. D) valvular stenosis.
The home health nurse is caring for a patient who has a comorbidity of hypertension. What assessment question most directly addresses the possibility of worsening hypertension?
A) "Are you eating less salt in your diet?" B) "How is your energy level these days?" C) "Do you ever get chest pain when you exercise?" D) "Do you ever see spots in front of your eyes?"
The home health nurse visiting an older Israeli client for a routine medication check determines that the client has declined since the last home visit
The nurse suggests that the client should be transported to the hospital; however, the family members state that they want the client to stay in the home. Which action by the nurse is most appropriate? A) Follow the decision of the family. B) Call for an ambulance to transport the client to a hospital. C) Ask the client's preference regarding transport to the hospital. D) Encourage the family to take the client to the hospital.
Which nursing action could the registered nurse (RN) working in a skilled care hospital unit delegate to an experienced licensed practical/vocational nurse (LPN/LVN) caring for a patient with a permanent tracheostomy?
a. Assess the patient's risk for aspiration. b. Suction the tracheostomy when needed. c. Teach the patient about self-care of the tracheostomy. d. Determine the need for replacement of the tracheostomy tube.