A nurse is screening a client for ATOD problems. Which of the following actions would the nurse most likely complete? (Select all that apply.)
a. Assist with identifying help or resources.
b. Advise about the need to enter a treatment program.
c. Ask about how relationships with family members and friends have been affected.
d. Assess amount and pattern of use.
ANS: A, D
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The nurse identifies the following assessment findings on a client with pre-eclampsia: blood pressure 158/100; urinary output 50 mL/hour; lungs clear to auscultation; urine protein 11 on dipstick; and edema of the hands, ankles, and feet
On the next hourly assessment, which of the following new assessment findings would be an indication of worsening of the pre-eclampsia? 1. Blood pressure 158/104 2. Urinary output 20 mL/hour 3. Reflexes 21 4. Platelet count 150,000
Which nursing action or statement is most likely to reduce anxiety in a client being brought to the surgical suite?
A. Asking the client if he or she has talked with the hospital chaplain B. Asking the client what specific surgery he or she is having done today C. Asking the client if he or she wants family members to be with them in the hold-ing area D. Explaining to the client that the surgical area is the most technologically advanced in the city
The conversion factor for converting tablespoons to milliliters is
A. 5 mL / 3 tbsp. B. 30 mL / 1 tbsp. C. 15 mL / 1 tbsp. D. 1 tbsp / 5 mL.
The nurse is assessing a client using the Mini-Mental State Examination (MMSE). The nurse would include which of the following activities as part of this examination?
1. Ask the client to recall a fond memory from the distant past. 2. Have the client name all the objects in the room. 3. Have the client walk 25 feet while carrying on a normal conversation. 4. Ask the client to repeat a phrase and to follow a direction.