A patient is diagnosed as being legally blind. What Snellen chart rating should the nurse expect when collecting data with this patient?
a. 20/20
b. 20/40
c. 20/100
d. 20/200
ANS: D
Legal blindness occurs at a Snellen chart rating of 20/200 with correction. A. B. C. These Snellen chart ratings do not indicate legal blindness.
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A patient with osteoarthritis in both knees states that she has difficulty with stairs, and her laundry room is in the basement. The most likely nursing diagnosis for this situation is:
1. Ineffective Coping related to pain. 2. Risk for Disuse Syndrome. 3. Risk for Infection. 4. Activity Intolerance.
An older patient requests a small, inflated donut to sit on to relieve pressure. What response by the nurse is appropriate?
1. "Ok, it will definitely help with relieving pressure." 2. "Using the donut can cause skin breakdown." 3. "I will need to obtain an order from the physician for you." 4. "I will give it to your wife and you can use this at home."
A histamine-receptor antagonist such as cimetidine (Tagamet) or ranitidine (Zantac) is ordered for an infant with GER. The purpose of this is to:
a. prevent reflux. b. prevent hematemesis. c. reduce gastric acid production. d. increase gastric acid production.
The home health nurse will visit a client who has just been referred to the agency for services. During the initial visit, which intervention would take priority?
1. Develop a plan of care and discuss it with the client. 2. Explain the nurse's role in assisting the client. 3. Determine the client's need for additional services. 4. Complete a physical assessment.