A home health care nurse is making a well-baby visit to the home of a new mother who has an infant. What assessment finding leads the nurse to provide further anticipatory guidance and teaching to the mother?
a. Mother states she does not breastfeed but uses a recommended formula.
b. Crib has colorful blankets and pillows for the baby to cuddle.
c. A mobile is hanging well above the crib playing soft music.
d. Several rattles and plush toys are available in different textures.
ANS: B
Objects such as pillows and blankets pose a suffocation hazard to infants and should be kept out of cribs. The other items are appropriate for a newborn.
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a. altered direction. b. organizational flux. c. planned change. d. status revision.
During the admission process, the registered nurse makes a nursing diagnosis of spiritual distress. Which question(s) may help clarify the situation? (Select all that apply.)
a. "What gives you meaning to life?" b. "Are there any spiritual objects that you want in your room?" c. "Do you want a particular spiritual counselor notified?" d. "Is there any special religious practice that you would want us to be aware of?" e. "What is your cultural background?"
A health care provider prescribes a client with heart disease to walk 20 yards 3 times a day. The client wants to know how many feet each day he is expected to walk. What should the nurse respond to the client?
1. 60 2. 120 3. 180 4. 210
Certain client psychiatric diagnoses have been associated with risk factors for assaultive behaviors. Which diagnoses have been associated with violent behavior? Select all that apply
A) Schizophrenia B) Bipolar disorder C) Somatization disorder D) Dependent personality disorder E) Borderline personality disorder F) Substance use disorder