A client has been brought to the emergency department for signs and symptoms of Chronic Obstructive Pulmonary Disease (COPD). The client has a history of a suicide attempt 1 year ago. Which nursing intervention would take priority in this situation?
A. Assessing the client's pulse oximetry and vital signs
B. Developing a plan for safety for the client
C. Assessing the client for suicidal ideations
D. Establishing a trusting nurse–client relationship
ANS: A
It is important to prioritize client interventions that assess the symptoms of COPD prior to any other nursing intervention. Physical needs must be prioritized according to Maslow's hierarchy of needs. This client's problems with oxygenation will take priority over assessing for current suicidal ideations.
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A client notices that the doctor writes "positive Chadwick's sign" on her chart. She asks the nurse what this means. The nurse's best response is:
a. "It refers to the bluish color of the cervix in pregnancy." b. "It means the cervix is softening." c. "The doctor was able to flex the uterus against the cervix." d. "That refers to a positive sign of pregnancy."
A hospitalized patient with impaired vision must get a picture in his or her mind of the hospital room and its contents in order to mobilize independently and safely. What must the nurse monitor in the patient's room?
A) That a commode is always available at the bedside B) That all furniture remains in the same position C) That visitors do not leave items on the bedside table D) That the patient's slippers stay under the bed
The nurse performs frequent neurovascular assessments for clients with musculoskeletal trauma in order to prevent:
A) CVA. B) compartment syndrome. C) DVT. D) fat embolus.
Which of the following characteristics BEST describes individuals with narcissistic personality disorder?
a. impulsive behavior, frequent anger at others, and a sense of emptiness b. overestimation of abilities, inflated self-esteem, and a sense of entitlement c. constantly seeking attention; excessively emotional, dramatic, and shallow d. manipulative, using others, charming, irritable, and bullying others