A 60 year old African American male with known hypertension comes to the emergency room with complaints of bad indigestion that has continued all night and a little bit of numbness in his left arm. What action should the admitting nurse take?
a. have the patient sit in the waiting room to be seen in order
b. treat him as if it he could be having a heart attack
c. give him some antacids immediately after checking with the physician
d. call 911 and let the paramedics decide what to do
B
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The nurse educator is preparing an in-service on pain management for the staff. One of the staff nurses asks, "What is the most important part of a pain assessment?" Which response by the nurse educator is the most appropriate?
1. "Pain is only partially subjective and primarily a physiologic experience, so vital signs are the most important assessment." 2. "A client's response to pain is always based on the underlying cause, so the client's admitting diagnosis is important." 3. "Vital signs are not reliable indicators of acute pain, because only some clients are able to elicit a change in blood pressure or pulse rate." 4. "The response to pain is unique and based on numerous factors, which need to be assessed."
Which statement made by the client starting on the drug cromolyn sodium indicates a need for clarification regarding the purpose, administration schedule, or side effects of this drug?
A. "If I get a skin rash, I will call my doctor right away." B. "I will keep using the drug even if I don't notice a difference in my asthma after the first week." C. "I will keep the inhaler with me at all times so that I can use it quickly when an asthma attack occurs." D. "I will hold my breath for 10 seconds after I trigger the inhaler so that more of the medicine stays in my lungs."
Which of the following interventions is most appropriate for the client with Parkinson's who is hospitalized with pneumonia?
A. Implement universal precautions B. Implement seizure precautions C. Implement falls precautions D. Use a geri-chair to provide out-of-bed activity
A preterm newborn, after spending 8 weeks in the NICU, is being discharged. The parents of the newborn express apprehension and worry that the newborn may still be in danger. The nurse should recognize that this is:
a. normal. b. a reason to postpone discharge. c. suggestive of maladaptation. d. suggestive of inadequate bonding.