A patient with swelling and a laceration above the right eye states, "I don't know what caused me to fall and cut my head on the door frame."
The patient's spouse appears nervous but smiles when mentioning that the patient is "so clumsy at times.". The nurse should give priority attention to which intervention when addressing this patient's needs? a. Directly asking the patient if spousal abuse is occurring or has ever occurred
b. Completing a thorough assessment that includes a focus on signs of old injuries
c. Interviewing the patient regarding the circumstances surrounding this suspicious fall
d. Notifying security that there is a possibility that this patient is a victim of physical abuse
B
The correct option reflects the nurse's appropriate attention to the determination of any physical indications that physical abuse may have occurred (Maslow's Hierarchy). The remaining options do not address this priority but rather focus on the emotional aspect of the situation.
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A client is receiving care in the hospital for life-threatening injuries sustained in a motor vehicle crash and is taken immediately to surgery
There is no family available to provide consent; however, the client's medical record is available and reviewed by the nurse. Which treatments are inappropriate in this situation? Select all that apply. A) Emergency surgery B) Treatment that was previously refused C) Treatment that violates religious beliefs D) Medications to treat the injury E) Experimental medications for a research study
The nurse is caring for a child with syndrome of inappropriate antidiuretic hormone (SIADH) disorder. Which interventions should the nurse implement for this child? Select all that apply
1. Encouragement of fluids 2. Strict intake and output 3. Administration of ordered diuretics 4. Specific gravity of urine 5. Weight on admission, but not daily
Surgical, medical, or mechanical methods may be used for labor induction. Which technique is considered a mechanical method of induction?
a. Amniotomy b. Intravenous Pitocin c. Transcervical catheter d. Vaginal insertion of prostaglandins
A nurse using the integrative model for community health promotion. Which of the following best describes how the nurse would apply the dimension of client system?
a. Concentrating on individual health be-haviors b. Studying client-centered initiatives c. Providing multidimensional nursing care among various levels of clients d. Focusing on disease-oriented care