The nurse is assessing a client recovering from abdominal surgery for the development of a deep vein thrombosis. Which of the following would indicate that the client is experiencing this disorder? (Select all that apply.)
1. Pain and tenderness of the lower extremity
2. Red area on a limb that is warm to the touch
3. Unexplained dyspnea
4. Chest pain
5. Hemoptysis
6. Drop in blood pressure
1, 2, 3, 4, 5
The client may describe limb pain as aching, cramping, sharp, dull, severe, or mild. Tenderness and pain of the lower extremity and a red area that is warm to touch are also indications that the disorder is present. Other signs and symptoms include unexplained dyspnea, chest pain, and hemoptysis. A drop in blood pressure is not an indication for a deep vein thrombosis.
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A child has sustained a minor burn. Which of the following should be included in increased amounts in the child's diet?
1. Protein 2. Minerals 3. Carbohydrates 4. Fats
The psychiatric–mental health nurse is asked to develop an intervention for the nursing unit based on Watson's theory of caring. Given this assignment, which intervention is most appropriate for the nurse to implement?
1. One-to-one debriefing sessions each week with individual unit nurses and the unit manager 2. Clarification of values and cultural beliefs that might pose barriers to caring for clients 3. Identification of additional coping skills for new nurses on the unit 4. Discussion of the impact of recent changes in hospital policy on the nursing staff
Nursing diagnoses offer a useful tool to assess culturally diverse patient needs
A. True B. False
A patient of Asian American descent recovering from abdominal surgery refuses all pain medication. What can the nurse do to ensure for this patient's comfort?
a. Provide a cup of tea. b. Offer to pray with the patient. c. Offer pain medication to promote healing. d. Document that pain medication is refused.