The nurse is listening to the fetal heart tones of a client at 37 weeks' gestation while the client is in a supine position. The client states, "I'm getting lightheaded and dizzy." What is the nurse's best action?
1. Assist the client to sit up.
2. Remind the client that she needs to lie still to hear the baby.
3. Help the client turn onto her left side.
4. Check the client's blood pressure.
3
Explanation: 3. During pregnancy the enlarging uterus may put pressure on the vena cava when the woman is supine, resulting in supine hypotensive syndrome. This pressure interferes with returning blood flow and produces a marked decrease in blood pressure with accompanying dizziness, pallor, and clamminess, which can be corrected by having the woman lie on her left side.
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Eddie, an RN, is charge nurse and is setting up the day's assignments. Lindsey, a newly licensed RN, has been floated to the unit. When making an assignment for Lindsey, Eddie must consider:
A) Lindsey's age B) Lindsey's knowledge of the institution's standards of practice C) Lindsey's nursing degree D) Lindsey's knowledge base and level of skill
Before beginning the health history interview, the nurse should perform all actions except:
a. Smile and ask the patient whether she has any special concerns. b. Speak in a relaxed manner with an even, nonjudgmental tone. c. Make the patient comfortable. d. Tell the patient her questions are irrelevant.
The educator is reviewing the neural mechanisms of pain with a nurse. Which information should the educator provide about substance P?
A. Substance P modifies sensory information in the spinal cord. B. Substance P is also known as an endogenous opioid. C. Substance P stimulates pain receptors in the spinal cord. D. Substance P controls which pain signals reach the brain.
Where is the nurse's description of the teaching provided to the client on performance of self-medication administration recorded?
a. Kardex form b. Incident report c. Nursing history form d. Discharge summary form