A client complains of anorexia, malaise, weight loss, joint pain, and stiffness. During assessment, the nurse expects to note:
1. constipation.
2. normal vision.
3. polycythemia.
4. butterfly rash over the nose.
Answer: 4
1. The client with systemic lupus erythematosus (SLE) usually experiences diarrhea.
2. Vision is affected in SLE, and the nurse would see conjunctivitis and photophobia.
3. The client experiences anemia, not polycythemia.
4. The classic sign of SLE is the butterfly rash over the nose.
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a. Acne b. Basal cell carcinoma c. Melanoma d. Squamous cell carcinoma
A patient is experiencing cardiogenic shock secondary to hypervolemia. The nurse should expect which of the following treatments to be ordered?
A) Albumin IV B) Cardioversion C) Diuretics D) Elevation of the feet
The nurse shines a light directly in front of the newborn's pupils. The purpose of this procedure is to check for
a. patency of the tear ducts b. conjunctivitis from prophylactic eye medication c. the presence of the red reflex d. eye hemorrhages manifested as lens cloudi-ness
Before assisting the client with feeding, the nurse should be sure to:
A. Assess the client's gag reflex B. Prepare the room and remove unpleasant smells C. Assist the client with elimination needs D. Assist the client with oral hygiene