Which of the following assessment findings is least helpful in identifying a cause of Ménière's disease?
A) Family history
B) Allergic reactions
C) Food intolerance
D) Head injury
C
Feedback:
There is no evidence that a food intolerance is an identifying cause of Meniere's disease. The other options are attributed to the disease.
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The skin of a client's feet is very taut with edema. Which of these skin parameters has the nurse assessed?
a. integrity c. turgor b. texture d. vascularity
Which nursing interventions related to self-care would be most appropriate for a moderately mentally-retarded teenager?
A) The nurse will perform all self-care to avoid injury to the client. B) The nurse will provide simple directions and praise the client's efforts to independently perform self-care. C) To promote autonomy, the nurse will not interfere with the client's self-care regimen. D) To promote bonding, the nurse will encourage family members to perform the client's self-care.
When faced with a scenario where it is believed that a client from another cultural background is using herbal remedies along with the prescribed medication to treat her arthritis. The nurse's first action should be to:
1. Educate the client concerning the danger of taking herbs and the prescribed med-ication 2. Inquire of the client as to the reason for using herbal remedies along with the pre-scribed medication 3. Ask the client to identify what herbal remedies are being used along with the prescribed medications 4. Alert the physician to the client's use of herbal remedies in addition to the pre-scribed medications
A client has been diagnosed with right-sided heart failure. What does the nurse expect to observe when assessing this client?
1. Decreased body temperature 2. Increased body temperature 3. Fatigue, shortness of breath, and cough 4. Peripheral edema