Assessing an older adult patient's ability to engage in activities of daily living is a part of which assessment?
A. Developmental
B. Functional
C. Cultural
D. Screening
Ans: B. Functional
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A nurse observes an infant in a crib lying still, without facial movements, except for occasional sucking movements. At this time, the nurse will avoid:
1. Assessing heart and respiratory rate. 2. Skin assessment. 3. Repositioning the head of the infant. 4. Attempts to feed the infant.
Which assessment findings should cause a nurse to be concerned that a patient is developing severe sepsis? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply
1. Serum creatinine level 2.0 md/dL 2. Absent bowel sounds 3. Onset of confusion 4. Heart rate 54 5. Blood pressure 148/90 mm Hg
A client is ordered to have a sitz bath following surgery. What would be a contraindication for a sitz bath treatment that would require the nurse to contact the surgeon for clarification?
A) Respiratory conditions B) Rectal discomfort C) Cardiac conditions D) Pelvic discomfort
The nurse is treating a client who presents in the ER with airway obstruction owing to laryngeal edema and vasodilation resulting in hypotension and hypoperfusion of the organs
Which of the following conditions is this client most likely experiencing? A) Serum reaction B) Anaphylaxis C) Graves' disease D) Systemic lupus erythematosus