The patient is an elderly gentleman who is admitted for a medical problem. While doing his admission assessment, the nurse learns that the patient gets up two to three times a night to use the restroom
The institution has only beds with four side rails. Which of the following is the appropriate rationale for leaving one of the lower side rails down? a. Falls rarely happen in the inpatient setting.
b. Having all side rails raised increases the occurrence of falling.
c. Side rails have no bearing on whether or not a patient falls.
d. Patient falls rarely result in physical injury.
B
Having all four side rails raised often increases the occurrence of falling, because patients try to climb over the rails to reach a chair or bathroom and often fall farther as a result. Leaving three side rails up (two upper and one lower) on a bed with four side rails is safer for the patient. Leaving the lower side rail down on the side of the bed the patient will exit the bed from to access the bathroom reduces the risk of falls.
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A patient is prescribed digoxin (Lanoxin), which affects the function of the sinoatrial node. Which of the following statements describes the function of the sinoatrial node?
A) The aortic cusp B) Normal pacemaker C) Contractile property D) Source of collateral circulation
An older adult client has been voluntarily admitted for treatment of alcohol dependency. In im-plementing care, the nurse plans which intervention based upon knowledge about alcohol and aging?
a. Assessing the client for both depression and anxiety b. Discussing the poor prognosis of this dis-order with the client c. Explaining the need for proper nutrition to minimize the effects of alcoholism d. Identifying the effects of chronic alcohol-ism on the human body
The first step in treating delirium is to
A. Give low-dose Haldol if the patient has psychosis B. Identify the cause C. Provide reality orientation D. Use side rails and/or wrist restraints to keep the patient safe
Why must nurses examine their attitudes about alcohol, tobacco, and other drug abuse and addiction before working with individuals with this health problem?
a. Working with clients who have addiction problems often puts the nurse at risk for violence. b. The population of persons with drug and alcohol addiction is found in low-income neighborhoods. c. To be therapeutic, a nurse must develop a trusting non-judgmental relationship with clients. d. Nurses are the primary persons who treat addiction problems.