When assessing for acute arterial occlusion, what would the nurse include? (Mark all that apply.)
A) Pain
B) Paralysis
C) Pallor
D) Paresthesia
E) Presence
A, B, C, D
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The nurse instructs the patient receiving treatment for hypothyroidism. Which of the following statements, if made by the patient, indicate the need for further teaching?
A) "I will continue to take the stool softener until my constipation is better.". B) "I will call the office if I have any chest palpitations.". C) "I will not need to refill this prescription.". D) "I will take one pill today, two tomorrow, and then three pills a day.".
You are caring for a patient who speaks a language different from your own. You recognize that special approaches for overcoming the language barrier would include which of the following? Select all that apply
a. Use clichés and jargon for a little humor b. Avoid defensive or offensive body language c. Use a different interpreter for each interaction d. Speak to the interpreter, rather than to the patient e. Provide reading material written in the appropriate language f. Use a culturally sensitive interpreter with fluency in health care terminology
When assessing a client's signs and symptoms of systemic lupus erythematosus (SLE) for staging, how does the nurse evaluate the stage of the disease?
A) By observing the client's gait B) By reviewing the medical record and diagnostic findings C) By inspecting the client's mouth D) By inspecting the client's lung sounds
The nurse is assessing the pain of a postoperative newborn. The nurse measures the infant's facial expression, body movement, sleep, verbal or vocal ability, consolability, and response to movements and touch
Which behavioral assessment tool is being used by the nurse? A) Riley Infant Pain Scale B) Pain Observation Scale for Young Children C) CRIES Scale for Neonatal Postoperative Pain Assessment D) FLACC Behavioral Scale for Postoperative Pain in Young Children