The nurse is caring for a client receiving hemodialysis. Which of the following assessments would be necessary to detect complications of disequilibrium syndrome?
1. Level of consciousness
2. Fluid intake
3. Temperature
4. Urine output
Level of consciousness
Rationale: With the removal of solutes in the blood more rapidly than from cerebrospinal fluid and the brain, changes in level of consciousness would be seen. Intake and output would not reflect a sign indicating disequilibrium syndrome. Monitoring temperature would indicate the possibility of infection, not disequilibrium syndrome. Monitoring urine output does not indicate a sign of disequilibrium syndrome.
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The nurse caring for mechanically ventilated clients knows that older adults are at higher risk for weaning failure. What age-related changes contribute to this? (Select all that apply.)
a. Chest wall stiffness b. Decreased muscle strength c. Inability to cooperate d. Less lung elasticity e. Poor vision and hearing
The nurse is caring for a patient who is not certain if she is in true labor. How might the nurse attempt to stimulate cervical effacement and intensify contractions in the patient?
a. By offering the patient warm fluids to drink b. By helping the patient to ambulate in the room c. By seating the patient upright in a straight-back chair d. By positioning the patient on her right side
When a toddler attempts to feed himself, the family should:
a. encourage the child to use a fork. b. feed the child themselves using a fork. c. encourage large portions for easier handling. d. offer the child finger foods.
A serious side effect associated with desmopressin is:
a. dehydration. b. hypotension. c. hyponatremia. d. urinary retention.