The nurse is caring for a client with inflammation and is doing the morning assessment. Which of the following manifestations indicate a systemic reaction associated with an inflammatory response?
1. Erythema
2. Pain
3. Tachypnea
4. Edema
3. Tachypnea
Rationale:
If the nurse observes a systemic reaction, the client will exhibit manifestations including temperature, increased pulse, tachypnea, and leukocytosis. Erythema, warmth, pain, edema, and functional impairment indicate a local reaction.
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A patient has been found to have expressive, or nonfluent, dysphasia following a stroke and is having difficulty communicating with his family. What would be the appropriate nursing intervention for this patient?
A) Explain to the family that the patient is intellectually impaired. B) Explain to the family that the patient is unable to understand the meaning of spoken language. C) Refer the patient to a rehabilitation specialist. D) Give the patient a note pad so that he can write responses to questions posed to him.
What has served as the model for presymptomatic testing?
A) Alzheimer's disease B) Huntington disease C) Tay-Sachs disease D) Sickle cell disease
The nurse would question the order for isotretinoin (Accutane) that was prescribed for a:
a. 20-year-old man with nodular acne who is an epileptic. b. 22-year-old woman with severe acne who is pregnant. c. 46-year-old woman with cystic acne who is on oral contraceptive pills. d. 50-year-old man with cystic acne who is on medication for hypertension.
Which vitamin does the nurse teach is essential to the function of clotting factors?
A) Vitamin D B) Vitamin E C) Vitamin C D) Vitamin K