While engaging in a high school sports activity, an adolescent sustains an injury to the nose. Which assessment findings indicate that the patient has a nasal fracture?
Select all that apply.
1. shortness of breath
2. diaphoresis
3. drop in blood pressures
4. periorbital ecchymosis
5. nasal bridge instability
Correct Answer: 4, 5
Manifestations of a fractured nose include periorbital ecchymosis and nasal bridge instability. Shortness of breath, diaphoresis, and a drop in blood pressure are not manifestations of a nasal fracture.
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a. cachexia. b. anorexia. c. neoplasia. d. catabolism.
An African American youth, growing up in an impoverished neighborhood, presents in the emergency department with bruises to his face, chest, and arms
He appears to be upset, is speaking in a dialect that is difficult for the nurse to understand, and is standing within 6 inches of the nurse's personal space. What cultural consideration should a nurse identify as playing a role in this youth's behavior? A. African Americans frequently speak in different tongues when they are upset. B. Most African Americans have learned to be aggressive when they have to see a health professional. C. African Americans tend to use dialects and invasion of personal space to intimidate others. D. Some African Americans speak in a dialect that is different from standard English and tend toward smaller personal space than that of the dominant culture.
An older adult with Lewy body dementia lives with family. After observing multiple bruises, the home health nurse talked with the daughter, who became defensive and said, "My mother often wanders at night. Last night she fell down the stairs."
Which nursing diagnosis has priority? a. Risk for injury related to poor judgment, cognitive impairments, and inadequate supervision b. Wandering related to confusion and disorientation as evidenced by sleepwalking and falls c. Chronic confusion related to degenerative changes in brain tissue as evidenced by nighttime wandering d. Insomnia related to sleep disruptions associated with cognitive impairment as evidenced by wandering at night
During a home visit the nurse is concerned that a new mother is experiencing postpartum blues. What did the nurse assess to make this clinical determination? Select all that apply
1. Fear 2. Anger 3. Euphoria 4. Anorexia 5. Weepiness