A child is admitted to the emergency department with a head injury. The nurse makes an assessment and will record which of the following baseline data:
a. Pupil size
b. Level of consciousness
c. Vital signs
d. All of the above
D
The nurse needs to monitor all of the above and establish a baseline from admission.
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An autocratic leader is likely to:
1. seek the employee's input. 2. be committed to what is best for the group. 3. allow workers to go ahead without direction. 4. make decisions independently.
Which of these statements should the nurse make to the client who had a right total knee replacement?
a. "You will ambulate with assistance the day after surgery." b. "You will be standing at the bedside on the evening of surgery." c. "You will stay in the hospital for 10 days." d. "You will keep the right leg in a dependent position when sitting up in a chair."
After auscultating a patient's chest, the nurse reports the findings to the preceptor. Which statement would indicate the need for immediate reassessment by the preceptor?
1. "I heard coarse crackles earlier, but now they sound finer.". 2. "I heard wheezing earlier, but now I don't hear it.". 3. "There are coarse crackles that clear with coughing.". 4. "The patient was clear, but now there are scattered wheezes bilaterally.".
A Department of Nursing within a medical center is adopting the theory that is founded on 14 fundamental needs of individuals. Which nurse theorist is this department using to guide client care?
1. Dorothea Orem 2. Florence Nightingale 3. Martha Rogers 4. Virginia Henderson