The nurse safeguards the client's safety by ensuring that which of the following is carried out during the admission process? Standard Text: Select all that apply
1. Using an interpreter if the client has difficulty understanding the language
2. Verifying the client's name with the name on the door
3. Verifying any allergies the client reports
4. Orienting the client to the hospital unit
5. Explaining all procedures as the admission process progresses
1,3,4,5
Rationale: Use of an interpreter will ensure that the client understands the questions being asked and directions being given.
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The nurse is testing the sensory development of a toddler brought to the clinic for a well visit. Which of the following might alert the nurse to a potential problem with the child's sensory development?
A) The toddler places the nurse's stethoscope in his mouth. B) The toddler's vision tests at 20/50 in both eyes. C) The toddler does not respond to commands whispered in his ear. D) The toddler's taste discrimination is not at adult levels yet.
The nurse must administer eardrops to an infant. How should she proceed?
1) Pull the pinna down and back before instilling the drops. 2) Pull the pinna upward and outward before instilling the drops. 3) Instill the drops directly; no special positioning is necessary. 4) Position the patient supine with the head of the bed elevated 30°.
A patient diagnosed with OCD paces up and down the corridor counting every tile. Select the nurse's best action
a. Offer to play cards with the patient in the dayroom. b. Ask the patient, "Why are you pacing and counting?" c. Take the patient's arm and escort the patient to a quiet area. d. Permit the patient to pace and count until feeling more comfortable.
Explain why identical twins are always of the same sex
What will be an ideal response?