The health care team is planning care for a client hospitalized following a suicide attempt. Which statement by a team member should serve as a basis for planning?
1. "A client who has made a recent suicide attempt is at low risk for another at-tempt."
2. "A client who has made a recent suicide attempt is at very high risk for another attempt."
3. "A client who has made a recent suicide attempt requires ongoing assessment to determine the level of risk."
4. "A client who has made a recent suicide attempt may be at risk for 24 hours until medication takes effect."
ANS: 3
Option 1 is incorrect, since a recent attempt is a risk factor for more attempts. The client could be at high risk (option 2), but more data are needed, so option 3 is correct. Option 4 is incorrect, since medication will not take effect in 24 hours.
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The nurse is reviewing the laboratory studies of a client and notes a serum sodium value of 168 mEq/L. Expected clinical manifestations this value would include:
1. Oliguria and fever 2. Constipation and decreased blood pressure 3. Muscle tremor and arrhythmias 4. Dizziness and confusion
A patient with third degree burns on both lower extremities from a house fire has been in the hospital for two weeks. The patient states, "I do not feel like walking today. I am going to stay in bed." What is the best response by the nurse?
A) "I understand. I have days like that too. Go ahead and stay in bed." B) "I am going to tell the doctor that you were not compliant with the order to get out of bed." C) "I will allow you to wait until the afternoon, but then you must get up." D) "It is important for your recovery to walk every day. Let's walk in the hallway for 10 minutes and then get a snack."
The emergency department has treated two patients in the last day with symptoms that may be H5N1. The nurse manager is updating staff on the pathophysiology of this disease. The manager would evaluate education as effective if which statement was made by a staff member?
1. It is thought that H5N1 is a nonhuman virus that has crossed species. 2. H5N1 is more common in patients also infected with HIV. 3. H5N1 is typically found in swine. 4. H5N1 is related to respiratory syncytial virus (RSV), so young children will be the most likely patients.
The nursing instructor teaches the students how medication errors can occur. Which common causes of errors will the instructor discuss?
1. The nurse does not validate a written order with the health care provider. 2. The nurse administers the incorrect drug. 3. The nurse miscalculates the medication dose. 4. The nurse misinterprets a health care provider's order. 5. The nurse does not check the client's identification band.