A client prescribed haloperidol (Haldol) is observed making wormlike movements with their tongue. Which should the nurse associate this finding with?
A. An adverse effect likely caused by the medication
B. A normal reaction to the medication that will resolve within a few weeks
C. An indication that the patient has not taken the prescription
D. A symptom of the underlying psychosis
Answer: A
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The nurse is caring for a client in the preoperative phase of surgery. Nursing interventions include: Standard Text: Select all that apply
1. Checking to be sure ordered test results are place in the medical record. 2. Performing preoperative teaching. 3. Assessing vital signs and pain. 4. Encouraging deep breathing. 5. Encouraging the client to turn from side to side.
A patient admitted for delirium demonstrates increased disorientation and agitation only during the evening and nighttime. The nurse documents this as:
a. evening. b. nighttime. c. bedtime. d. sundowning.
At what point in the nurse-client relationship should the nurse plan to first address the issue of
termination? a. In the working phase b. In the termination phase c. In the orientation phase d. When the client initially brings up the topic
A patient comes to the industrial nurse and is frantic because the stoma to the colostomy has prolapsed 1 year after surgery. What is the best response by the nurse?
a. "If there are still feces coming from the stoma, then it is not blocked. Contact your surgeon for an evaluation." b. "You must come in immediately because the stoma may completely retract into your abdomen." c. "This is an emergency situation because it has stenosed." d. "Don't worry about that. Coughing or sneezing might have caused the prolapse. It will come back out in a few hours."