The nurse is preparing to document care provided to a client who received rescue breathing while being transported to radiology. Which items will the nurse include in the documentation for this client?
Select all that apply.
1. Date and time of event
2. Factors that precipitated the event
3. Length of time with no breathing
4. Response to rescue breathing
5. Tasks assigned to the unlicensed assistive personnel
Correct Answer: 1,2,3,4
When documenting this event in the medical record, the nurse will include the date and time the event occurred, any factors that precipitated the event, the length of time that the client was not breathing, and the client's response to rescue breathing. It is unnecessary to document the tasks that were assigned to the unlicensed assistive personnel during this event.
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A nurse is teaching a client with chronic migraine headaches. Which statement related to complementary therapy should the nurse include in this client's teaching?
a. "Place a warm compress on your forehead at the onset of the headache." b. "Wear dark sunglasses when you are in brightly lit spaces." c. "Lie down in a darkened room when you experience a headache." d. "Set your alarm to ensure you do not sleep longer than 6 hours at one time."
The nurse is conducting a staff in-service on multifetal pregnancy. Which statement about dizygotic twin development should the nurse include in the teaching session?
a. Dizygotic twins arise from two fertilized ova and are the same sex. b. Dizygotic twins arise from a single fertilized ovum and are always of the same sex. c. Dizygotic twins arise from two fertilized ova and may be the same sex or different sexes. d. Dizygotic twins arise from a single fertilized ovum and may be the same sex or different sexes.
What is the name of the chemicals that allow nerve impulses to cross the synaptic cleft?
1. Neurotransmitters 2. Neurons 3. Autonomic drugs 4. Presynaptic neurons
Whether a nurse's plan of care for a community is acceptable is probably determined by which aspect of the plan?
a. It was created in coordination with community members. b. It was financially feasible. c. It was politically correct and feasible. d. It was something in which the nurse really believes.