A patient presents at the emergency room reporting "the worst headache I have ever had." What are critical nursing behaviors for this patient? (Select all that apply.)
A) MRI
B) Physical examination for neurologic changes
C) CT scan
D) Focused history
E) EEG
B, D
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A unit secretary is chronically late returning from breaks. The rest of the secretary's work is excellent and he is always helpful and supportive of nurses and client families
The nurse manager has discussed the lateness with him, but it has not stopped. Thinking this might be an attention-seeking behavior, the manager decides to use extinction as a strategy. What should the manager do? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Offer the secretary a free lunch if he can go 1 week without being late. 2. Ignore the behavior. 3. Place a large alarm clock in the break room and set it each time the secretary takes a break. 4. Plan to be away from the secretary's area during his break times. 5. Tell the secretary that one more late return will result in a written critical incident report.
The nurse preparing a care plan for a patient who has sustained a deep partial-thickness burn injury will give the highest priority to which of the following nursing diagnoses?
A) Activity intolerance B) Anxiety C) Impaired nutrition: less than body requirements D) Acute pain
A patient who came to the clinic after finding a mass in her breast is scheduled for a diagnostic breast biopsy. What is a priority nursing action?
A) Acknowledge the fear the patient is experiencing. B) Refer her to a breast cancer recovery group. C) Set up a consultation with a breast cancer survivor. D) Instruct the patient on prosthetic devices.
On assessment immediately following cardiac surgery, which of the following conditions would you expect to find in an infant?
A) Hypothermia B) Hypovolemia C) Hypertension D) Hyperexcitability