The nurse is caring for a patient with acquired immune deficiency syndrome (AIDS) dementia complex (ADC). Which factor places this patient at particular risk for injury?
a. Manic behavior
b. Numbness and muscle weakness
c. Suicidal ideation
d. Difficulty concentrating
B
Peripheral neuropathy results in numbness and muscle weakness that may contribute to falls and thermal skin injuries.
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The newly hired graduate nurse learns she will be placed on probation for the first six months of employment. Which of the following explain the purpose of the probationary period? Select all that apply. Standard Text: Select all that apply
1. Determine an appropriate salary based on the type of work performed. 2. Determine ability to perfect skills and perform them in a timely manner. 3. Determine if others working in the facility like the new nurse. 4. Allow the newly hired nurse to determine if this is the correct facility for her. 5. Determine if the graduate nurse is able to work as a member of the team.
An all-hazards command center should ____
a. Facilitate planning meetings b. Provide a place for the commander to sleep c. Be operated by an emergency room triage nurse d. Be located near the security department
A patient has a wound on his thigh that is swollen and red. The nurse assesses that the surrounding tissue has a dusky blue color with a few small dark blisters. Which other assessment findings would cause the nurse to alert the healthcare provider about possible necrotizing fasciitis (NF)?
1. Blood pressure is 140/90 mm Hg. 2. The patient reports recently taking steroids for a severe ear infection. 3. The patient works in an elementary school. 4. The patient reports pain as a 9 on the 1 to 10 pain scale. 5. The patient's body mass index is 31.
List eight independent nursing measures and the rationale for the use of each that nurses
implement to decrease or control increased ICP in closed head injury. What will be an ideal response?