The nurse is to ambulate a client who has an IV in her arm, an indwelling urinary catheter, and a chest tube. What action is appropriate for the nurse to take?
a. Hold the IV so it is higher than the client's heart while ambulating.
b. Empty the urinary drainage bag before ambulating.
c. Empty the closed chest drainage system before ambulating.
d. Hold the closed chest drainage system above the client's chest level while ambulating.
ANS: B
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A patient comes to the emergency department in the irreversible stage of shock. The best nursing intervention would be:
A) Provide opportunities for the family to spend time with the patient and help them to understand the irreversible stage of shock. B) Inform the patient's family early that the patient will likely not survive, which allows the family time to make plans and move forward. C) Closely monitor fluid replacement therapy and inform the family that the patient will probably survive and return to normal life. D) Protect the patient's airway, optimize intravascular volume, and support the pumping action of the heart.
Using the Pain Assessment in Advanced Dementia (PAINAD) tool, the nurse assesses a patient with Alzheimer disease to have a score of 5. The nurse prepares to treat this patient for which level of pain?
A) No pain B) Mild pain C) Moderate pain D) Severe pain
A patient tells a nurse, "I want my own private room because my roommate is always watching football on television. He probably thinks I'm gay because I don't like football."
Which communication best reflects a cognitive behavioral assessment by the nurse? a. "You feel your roommate thinks you're gay because you don't like football and he spends his time watching football? How will getting a private room change things?" b. "It's hard to feel excluded, but isolating yourself is not the answer. Perhaps you might try watching football with him.". c. "Don't you think your roommate will be more likely to think you're gay if you get a private room?" d. "Well, you must realize that most men like football, but that doesn't mean he will think you are gay.".
Researchers formulated hypotheses based on clear definitions of
a. concepts and variables. b. empirical indicators. c. likely risk factors. d. populations to be included.