A client admitted to the emergency department with "excruciating chest pain, above the rating of 10," has a heart rate of 55, rapid, irregular respirations, complains of nausea,
and is too weak to move to the stretcher by himself. The nurse recognizes that this response to severe pain is due to the response of the:
a. Parasympathetic nervous system.
b. Sympathetic nervous system.
c. Central nervous system.
d. Peripheral nervous system.
ANS: A
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1. Adduction 2. Opposition 3. Flexion 4. Extension
The nurse is concerned that a client is at risk for a nosocomial infection. What did the nurse assess to make this clinical decision?
1. Client is receiving intravenous fluids. 2. Client has an indwelling urinary catheter. 3. Client is recovering from surgery. 4. Client is receiving pain medication. 5. Client is ambulating twice a day with assistance.
A nurse is evaluating a 17-year-old boy's comprehensive cholesterol laboratory work. The result is 132 mg/dl. The nurse knows that:
1. This is too high, and the boy should get a referral for a nutritionist. 2. This is too high because of the types of foods teens prefer to eat. 3. This is within normal limits, and the boy should continue with the same eating style. 4. This is within normal limits because of the higher level of metabolism in teens.
What is one principle related to a patient's hygiene and grooming?
What will be an ideal response?