Which nursing assessment is most important to determine fluid status for a patient with heart failure?
a. Auscultation of lungs
b. Daily weights
c. Intake and output
d. Measurement of abdominal girth
ANS: B
Daily weights are the best indicator of fluid gain or loss. Auscultation of lungs, measurement of intake and output, and measurement of abdominal girth are not the best indicators of fluid status.
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The nurse is preparing to perform an otoscopic exam of the ear. The patient is restless but has agreed to the exam. List in order of priority the steps the nurse would perform
Choice 1. Explain the procedure to the patient. Choice 2. Grasp the superior portion of the auricle and pull up, out, and back to straighten the auditory canal. Choice 3. Hold the handle of the otoscope in the dominant hand, otoscope handle upward. Choice 4. Wash the hands. Choice 5. Turn on the otoscope light. Choice 6. Rest the hand holding the otoscope against the patient's head.
Members of the staff on a hospital unit are critical of a client's family, who has different cultural beliefs about health and illness. A student assigned to the patient does not agree,based on her care of the client and family
What critical thinking attitude is the student demonstrating? A) Being curious and persevering B) Being creative C) Demonstrating confidence D) Thinking independently
A client with a sexually transmitted illness (STI) asks the nurse to not tell anyone about the diagnosis. According to the Health Insurance Portability and Accountability Act (HIPAA) of 1996, what must the nurse do?
1. Honor the client's wishes. 2. Not disclose any information to anyone. 3. Respect the client's privacy and confidentiality. 4. Communicate only necessary information.
Community-oriented nursing needs vary by community. However, there are prevailing needs in most rural areas, especially the following
1. Occupational health 2. Acute hospital care 3. Emergency care services 4. Psychiatric in-patient care