To perform a deep tendon reflex measurement, you should:
a. briskly tap the tendon with the rubber end of the hammer.
b. place the hammer firmly on the tendon for 3 to 5 seconds.
c. tap the silver end of the hammer on the tendon.
d. use the needle implement to determine sensory perception.
A
Deep tendon reflexes are measured by quickly and firmly tapping either end of the rubber ham-mer on the stretched tendon and then observing muscle movement.
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Which initial nursing intervention should be planned for a newly admitted patient with acute mania?
a. Allow the patient to act out suppressed feelings because the environment is safe. b. Provide verbal instructions to the patient to remain calm and cooperative. c. Be accessible to set limits on the patient's behavior as necessary. d. Restrain the patient to reduce hyperactivity and aggression.
The client makes the following statement: "I'm afraid to take the baby home tomorrow." Which response by the nurse would be the most therapeutic?
a. "You're afraid to take the baby home?" b. "I was scared when I took my first baby home, but everything worked out." c. "You should read the literature I gave you before you leave." d. "Don't you have a mother that can come and help?"
A male client displaying acute mania has disrobed in the hall three times in 2 hours. The nurse
should a. direct the client to wear his clothes at all times. b. ask if the client finds the clothes bothersome. c. tell the client he is embarrassing the women. d. arrange for one-on-one supervision.
A patient is scheduled to receive a liver for transplantation from a person who has died. The nurse realizes that the type of cadaver donor for the liver would be one who
1. died of cardiac death. 2. died in an automobile accident. 3. died of natural causes. 4. died of brain death.