A nurse who is assessing a client's eyes finds that the pupils are equal, round, and react to light and accommodation (PERRLA). These findings verify the normal functioning of which cranial nerve?
a. Optic cranial nerve (CN II)
b. Oculomotor cranial nerve (CN III)
c. Trochlear cranial nerve (CN IV)
d. Abducens cranial nerve (CN VI)
ANS: B
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The first formal training school for the practical nursing student was which of the following?
1. Young Women's Christian Association 2. Elizabeth Kenny Institute 3. The Alexian Brothers school of nursing 4. The Ballard School
A teen is brought to the emergency department by a parent. The nursing assessment reveals that the patient has been acting strangely for the past three hours and is hypervigilant, grandiose, and irritable
Vital signs reveal hypertension, tachycardia, and some arrhythmias. Which substance does the nurse suspect that the teen has been using? 1. Alcohol 2. Marijuana 3. Heroin 4. Amphetamines
A nurse is placing an infant in a mummy restraint in order to perform eye care. Which of the following is a recommended guideline for application of a mummy restraint?
A) Place the child on the blanket, with edge of blanket at or above neck level. B) Position the child's left arm alongside the body and pull the right side of the blanket over the shoulder and chest. C) Leave the lower part of blanket open and pull the sides of the blanket over the child's body. D) Secure the blanket under the child's body on each side by tucking it in instead of using safety pins.
MC Clinical Situation: You have just completed an admission assessment on the following client, and based on the collected data, you begin the client care plan
The client is a 39-year-old single male admitted for upper right-quadrant pain following a week-long episode of flu-like symptoms. He has not eaten for 7 days and presents with signs and symptoms of dehydration and malnutrition. He has not been out of bed during the week. He lives alone and states he either buys frozen foods or eats in fast-food restaurants. The question below refers to the client care plan. (When filling in the content in the care plan, remember that the material is not necessarily related. This exercise is designed to determine your care plan knowledge base, not your medical knowledge.) Based on the collected data, select the letter of the short-term goal that is the most appropriate. Write the selected short-term goal in the appropriate section of the care plan. A. Improved skin turgor within 24 hours. B. Respiration unlabored and 20/minute. C. Able to ambulate without assistance. D. Noncompliance related to poor dietary habits.