A nurse on a medical-surgical unit asks a licensed practical nurse (LPN) to help with nutritional assessments for newly admitted patients. What part of the nutritional assessment can be delegated to the LPN? Select all that apply
a. Height and weight
b. Intake and output
c. Nutritional history
d. Interpreting laboratory findings
e. Body fat measurement
ANS: A, B, C
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A patient has been treated in the emergency room for epistaxis. What information should the nurse include in patient discharge teaching to prevent epistaxis?
A) Keep nasal passages clear. B) Use a dehumidifier. C) Avoid picking the nose. D) Use a tissue when blowing the nose.
The nurse is caring for a mechanically ventilated patient with a pulmonary artery catheter who is receiving continuous enteral tube feedings. When obtaining continuous hemodynamic monitoring measurements, what is the best nursing action?
a. Do not document hemodynamic values until the patient can be placed in the supine position. b. Level and zero reference the air-fluid interface of the transducer with the patient in the supine position and record hemodynamic values. c. Level and zero reference the air-fluid interface of the transducer with the patient's head of bed elevated to 30 degrees and record hemodynamic values. d. Level and zero reference the air-fluid interface of the transducer with the patient supine in the side-lying position and record hemodynamic values.
A client is brought to the emergency department via rescue squad with suspicion of cardiogenic pulmonary edema. What complication should the nurse monitor for? Select all that apply
A) Nausea and vomiting B) Pulmonary embolism C) Cardiac dysrhythmias D) Respiratory arrest E) Cardiac arrest
A client is voiding 50 to 100 mL of urine every few hours and reports urgency with voiding. The nurse reports this as an abnormal finding based on the understanding that:
A) the urge to void occurs at 300 to 500 mL in the bladder. B) it is abnormal to urinate every few hours. C) it is normal to void at least 600 to 700 mL with each bladder emptying. D) urgency is always a sign of a bladder infection.