The nurse has just received report on a group of clients. Which client will the nurse assess first?

A. Young adult who was in a car accident and has a 13 Glasgow Coma Scale score
B. Adult who had a cerebral arteriogram and has a cool, pale right leg
C. Middle-aged adult who has a headache after undergoing a lumbar puncture
D. Older adult who has expressive aphasia after a left-sided stroke


Ans: B. Adult who had a cerebral arteriogram and has a cool, pale right leg

Nursing

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The nurse is caring for a patient who has just died in a motor vehicle accident

What is the priority action of the nurse before the patient's family arrives to see the patient's body? a. Gently wash the body and provide perineal care. b. Remove the patient's dentures and jewelry. c. Ensure that the death certificate has been signed. d. Determine which funeral home will pick up the body.

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When giving a medicine through a nasogastric (NG) tube, which will the nurse do first?

a. Flush the tube with 30 mL of water. b. Check placement of the tube. c. Take the vital signs. d. Ask the patient if the tube is painful.

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You note mild inflammation and injection (redness around the cornea) of your patient's conjunctiva, with the presence of follicles. This finding most likely indicates

a. allergic conjunctivitis. c. infectious pinguecula. b. bacterial conjunctivitis. d. viral conjunctivitis.

Nursing

The patient receives warfarin (Coumadin) and becomes pregnant. The physician changes her anticoagulant to enoxaparin (Lovenox). She asks the nurse, "Why did the doctor do that?" What is the best rationale by the nurse?

1. "Because it is easier to maintain your bleeding times in a therapeutic range." 2. "Because warfarin (Coumadin) is known to cause serious cardiac defects." 3. "Because you are less likely to have bleeding with enoxaparin (Lovenox)." 4. "Because enoxaparin (Lovenox) cannot get into your baby."

Nursing