A nurse assessing a postoperative ureterostomy client will interpret that the stoma has normal characteristics if the stoma is:
1. Dry
2. Pale
3. Dark-colored
4. Red and moist
4
Rationale: Following ureterostomy, the stoma should be red and moist. A dry stoma may indicate fluid volume deficit. A pale stoma may indicate an inadequate vascular supply. Any darkness or duskiness of the stoma may mean loss of vascular supply and must be corrected immediately to prevent necrosis.
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The nurse caring for the pregnant woman should be aware that the U.S. birth rate shows what trend?
a. Births to unmarried women are more likely to have less favorable outcomes. b. Birth rates for women 40 to 44 years of age are beginning to decline. c. Cigarette smoking among pregnant women continues to increase. d. The rates of pregnancy and abortion among teens are lower in the United States than in any other industrialized country.
The nurse is caring for a patient who has asthma. The provider has ordered an albuterol metered-dose inhaler (MDI), 2 puffs q4 to 6h PRN wheezing. The patient's last dose was 4 hours ago. What is the nurse's next action?
a. Administer 2 puffs of albuterol with the MDI. b. Auscultate the patient's lung sounds. c. Give the albuterol if the patient reports wheezing. d. Give the medication and evaluate its effectiveness.
A client in the second trimester of pregnancy is seen in the health care clinic. The client tells the nurse that she is a hostess at a local restaurant and is on her feet most of the day
She states that she has frequent low back pains and ankle edema by the end of the day. The nurse provides in-structions to the woman about measures to relieve the discomfort. Which of the following state-ments, made by the client, indicates an understanding of how to relieve these discomforts? 1. "When I get home I should lie on my left side, with my feet in a dorsiflexed posi-tion." 2. "I should soak in a tub bath of hot water when I get home and then perform pel-vic tilt exercises." 3. "When I get home I should lie on my right side, with my feet elevated on a pil-low, and put a heating pad on my back." 4. "When I get home I should lie on the floor, with my legs elevated onto a couch, and turn my hips and knees at right angles."
Which of the following definitions of visual impairment most emphasizes the clearness of vision at various distances (visual acuity)?
a. educational c. legal-medical b. functional d. common usage