Which tools are not anticipated when conducting a newborn assessment?
1) Tape measure
2) Goniometer
3) Stethoscope
4) Otoscope
ANS: 2
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The nurse is caring for a client with dyspnea resulting from pulmonary edema secondary to congestive heart failure. The health care provider is notified, and the nurse receives a verbal order for Lasix 40 mg STAT
Which action by the nurse is the most appropriate? 1. Administer the medication immediately. 2. Clarify the route for administration. 3. Give the medication IV because the client is in distress and rapid effects are needed. 4. Hold the medication until the prescriber comes to the unit to clarify route and sign the order.
A patient has to sign a release for all information in his or her medical record, except for the use of photos contained in the medical record.
Answer the following statement(s) true (T) or false (F)
A patient is being admitted to the intensive care unit after being resuscitated in the emergency department. The patient is being mechanically ventilated. Which information provided by the transferring nurse would the nurse evaluate as increasing this patient's risk of developing ventilator-associated pneumonia (VAP)?
1. "The patient is intubated nasally." 2. "The patient arrested after having a myocardial infarction." 3. "The patient required placement of a nasogastric tube to relieve persistent gastric distention." 4. "The patient's home medications include a proton pump inhibitor." 5. "The patient has a history of chronic obstructive pulmonary disease (COPD)."
The parents are concerned about how their teen will be able to handle normal daily activities because of the brace. The nurse would offer which of the following instructions to help the family cope with this new challenge:
a. Instruct parents to remove any potential hazards in the home b. Instruct the teen to be especially careful when walking in the school halls when changing classes c. Put clothing on lower part of the body while sitting in a chair d. All of the above