A nurse assesses a patient's dorsalis pedis pulse. If the pulse is not palpable when light pressure is applied, the nurse should document this finding as a:
a. weak pulse.
b. normal pulse.
c. thready pulse.
d. bounding pulse.
A
A thready pulse is difficult to feel and is not palpable when only slight pressure is applied. A weak pulse is somewhat stronger than a thready pulse but not palpable when light pressure is applied. A normal pulse is easily felt but not palpable when moderate pressure is applied. A bounding pulse feels full and springlike even under moderate pressure.
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A client believes she has a brain tumor despite numerous diagnostic tests that show no evidence of a
tumor. She tells the nurse "People with brain tumors vomit. Yesterday I vomited all day. I know I have a brain tumor.". The approach that fosters cognitive restructuring is a. "You do not have a brain tumor. The more you talk about it, the more it reinforces your illogical thinking. We'll talk about something else.". b. "Let's see if there are any other possible explanations for your vomiting.". c. "How worried you seem! Let's talk about how you're feeling.". d. "What interpersonal problems have you had recently?"
After removing the wet clothing from a patient who fell through the ice into cold water, the nurse wraps the patient in warm blankets to prevent heat loss by which means?
A) Radiant heat loss B) Evaporative heat loss C) Convective heat loss D) Conductive heat loss
A nurse educates a patient with newly diagnosed diabetes about his illness. The patient asks where he can find information on the Internet. The nurse's best recommendation is
1. A blog. 2. WebMD. 3. Wikipedia. 4. A commercial site.
When evaluating the reflexes of a newborn, the nurse notes that with a loud noise the newborn symmetrically abducts and extends his arms, the fingers fan out and form a "C" with the thumb and forefinger, and he has a slight tremor
The nurse would document this finding as a positive: 1. tonic neck reflex. 2. glabellar (Myerson) reflex. 3. Babinski reflex. 4. Moro reflex.