Clients A and B are identical twins. Although they look alike, they respond very differently to stress. Whereas client A tends to get irritable and uptight, client B withdraws from the situation and occasionally cries
How might this differential response to stress be best explained by a nurse?
A) Anxiety and grief are thought to be two primary psychological response patterns to stress.
B) Anger and withdrawal are thought to be two primary psychological response patterns to stress.
C) Both irritability and withdrawal are manifestations of depression.
D) Environmental influences on the stress response weigh more heavily than genetic influences.
A
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A nurse in an acute medical unit of a hospital has admitted a 62-year-old female from the emergency department who has been diagnosed with acute pyelonephritis
Which of the following statements most accurately conveys an aspect of the knowledge base that the nurse needs to perform adequate care and teaching? A) Most cases of acute pyelonephritis are attributable to poorly controlled hypertension. B) Flank pain, dysuria, and nausea and vomiting are likely assessment findings. C) The infection in the kidney is most likely a manifestation of a systemic infection. D) Imaging tests are likely to reveal scarring and deformation of the renal calices and pelvis.
Which situations portray leadership development according to behaviorist theory? Select all that apply
1. The nurse manager of the Emergency Department is certified as a nursing administrator. 2. Those staff reporting to the chief nursing officer think he was born to be in nursing management. 3. The assistant nurse manager in the Intensive Care unit has attended five leadership seminars in the last two years. 4. The charge nurse working today has been a charge nurse for the past 10 years of her 20 years' experience as a registered nurse. 5. The nurse manager of surgical services is honest, fair, and dependable, and so must be successful as a leader.
L.S. is a 7-year-old who has been brought to the emergency department (ed) by his mother. she imme-
diately tells you he has a history of ed visits for his asthma. He uses an inhaler when he wheezes, but it ran out a month ago. she is a single parent and has two other children at home with a babysitter. your assessment finds L.s. alert, oriented, and extremely anxious. His color is pale, and his nail beds are dusky and cool to the touch; other findings are heart rate (HR) 136 beats/min, respiratory rate (RR) 36 breaths/ min regular and even, oral temperature 99.1 ° F (37.3 ° C), spo2 89%, breath sounds decreased in lower lobes bilaterally and congested with inspiratory and expiratory wheezes, prolonged expirations, and a productive cough. As you ask L.s.'s mother questions, you note that L.s.'s RR is increasing; he is sitting on the side of the bed, leaning slightly forward, and is having difficulty breathing. you are concerned that he is experiencing status asthmaticus. You check the orders and need to decide which interventions are the priority at this time. Select all that apply and explain the rationale. a. Monitor HR and RR every 2 hours b. Administer oxygen via face mask to keep Spo2 above 90% c. Have L.S. lie flat d. Administer albuterol (Proventil) and ipratropium bromide (Atrovent) via hand-held nebulizer (HHN) STAT e. Reassess in 20 minutes, and if no improvement, administer salmeterol (Serevent Diskus) via dry-powder inhaler (DPI) f. Start IV normal saline (NS) at 15 mL/hr and administer methylprednisolone 2 mg/kg IV STAT × 1 dose g. Have L.S. perform incentive spirometry h. Encourage PO fluids as tolerated
The government standards regarding mechanical and physical restraints identify that:
A. Alternative measures are to be implemented first B. The nurse's judgment is all that is required for their implementation C. Restraints should be used immediately for all clients who may need them D. Restraints cannot be used except to prevent others from being harmed