The nurse is reinforcing teaching provided to a patient with aortic regurgitation on how to reduce cardiac workload. Which patient statement indicates that teaching has been effective?
a. "Lie flat when in bed."
b. "Elevate the legs hourly."
c. "Eat three large meals daily."
d. "Alternate activity with rest."
ANS: D
Cardiac workload and oxygen needs are reduced with rest. A. Lying flat may be uncomfortable for the patient with this health problem. B. The legs do not need to be elevated every hour. C. Large meals might be uncomfortable for this patient and should not be encouraged.
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The nurse is assessing the blink reflex in a client who is blind. Which is the best technique to use?
a. Ask the client to blink first with one eye and then with the other. b. Expel a syringe of air toward the client's eyes. c. Shine a bright light at the client's pupils one at a time. d. Suddenly bring a finger toward the client's face.
A patient seen in the emergency department for priapism is sent to the medical unit
The admitting nurse should anticipate performing which actions as part of the nursing care plan? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Assess the penis for color changes. 2. Assess the penis for firmness and rigidity. 3. Administer an analgesic as prescribed for pain. 4. Apply ice packs as prescribed. 5. Push oral fluids.
You are completing a general physical examination on Mr. Rock, a 39-year-old man with complaints of constipation. When examining a patient with tense abdominal musculature, a helpful technique is to have the patient:
a. hold his or her breath. b. sit upright. c. flex his or her knees. d. raise his or her head off the pillow.
The nurse is working with a pregnant teen. In order to accurately assess the teen's nutritional intake, the nurse should:
A. Assess laboratory values. B. Ask her to complete a 24-hour dietary recall. C. Observe for clinical signs of malnutrition. D. Ask about her cooking facilities.