The nurse listens as the physician informs the client of the diagnosis of colon cancer and explains the need to remove the colon and create an ileostomy. When the physician leaves, the nurse's priority of care is directed at:
1. Instructing the client how to prepare for surgery.
2. Instructing the client about care of the postoperative ostomy.
3. Supporting the client and family's emotional needs.
4. Leaving the client and family alone to grieve.
3
Rationale: The client and family will require support to deal with their emotional response to learning that the client has cancer and will undergo body-image changing surgery. Now is not the time to begin instructions, because the client most likely will be unable to learn or concentrate on what the nurse is teaching.
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The nurse knows that the two factors that often differentiate major depression from dysthymia depression are:
A. Amounts of mania and sadness. B. Presence or absence of anger and guilt. C. Severity and duration of symptoms. D. Patient's gender and age.
A mountain biking accident has resulted in blunt trauma to a patient's right upper and right lower abdominal quadrants. The emergency room nurse should recognize that this patient's injuries create a high risk of:
A) Orthopedic trauma B) Metabolic acidosis C) Thromboembolism D) Hemorrhage
The nurse is preparing to assess the posterior spine of a client. Which landmark should the nurse use to determine symmetry?
A. Paravertebral muscles. B. Iliac crests. C. Posterior superior iliac spine. D. Twelfth thoracic vertebrae.
A 68-year-old woman had an appointment to see the public health department outreach coordinator. Where would this client most likely reside?
a. In a nursing home b. In an assisted-living complex c. In one of her children's homes d. Independently in her own housing