An 80-year-old man arrives in the emergency department after suffering a severe heart attack. His condition is deteriorating and the physician informs the wife, also an older adult, that they do not expect him to live
The wife begins to cry uncontrollably and tells the nurse, "We have been married for 60 years. What am I going to do?" What is the most appropriate response by the nurse?
a. "You had a good life together. You just need to understand that death is part of life too."
b. "I understand how you feel but he did live to 80 years old. That's a good long life."
c. "I will get a social worker to see you for some help you may need at home."
d. "I understand that this is an incredible and unexpected loss for you."
ANS: D
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A nurse suspects that a postpartum client has mastitis. Which of the following assessments provides the data to support this assessment? (Select all that apply.)
A. Shooting pain in her nipple during breastfeeding B. Late onset of nipple pain C. Pink and flaking skin of the affected breast D. Nipple soreness when the infant latches on E. Sudden onset of fever
The nurse is performing a breast examination. Which of these statements best describes the correct procedure to use when screening for nipple and skin retraction during a breast examination? Have the woman:
a. Bend over and touch her toes. b. Lie down on her left side and notice any retraction. c. Shift from a supine position to a standing position, and note any lag or retraction. d. Slowly lift her arms above her head, and note any retraction or lag in movement.
A client with catatonic schizophrenia exhibits little spontaneous movement and demonstrates waxy
flexibility. The client's needs of priority importance are a. physical. b. psychosocial. c. safety and security. d. self-actualization.
Which body area should never be used to inject insulin?
a. The actual umbilicus b. The outer thighs c. The upper arms d. The lower back