The nurse is instructing the client on how to perform Credé's maneuver. In which situation is this maneuver helpful?
A) When a client is experiencing a vagal response during a bowel movement
B) When a client is experiencing orthostatic hypotension upon arising
C) When a client is attempting to empty the bladder
D) When a client is experiencing numbness of the lower extremities
C
Feedback:
Credé's maneuver is intended to increase abdominal pressure and facilitates the emptying of the bladder. The nurse instructs the client to bend at the waist or press inward and downward over the bladder. The other options are not correct.
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The nurse finds a patient sitting in bed, crying. What should the nurse do when the patient says that nothing is wrong?
A) Ignore the problem because the patient obviously does not wish to talk. B) Document the patient crying and go back to see the patient later in the shift. C) Sit in the chair beside the patient's bed, and maintaining eye contact, ask a few questions about the day. D) Fill the patient's water pitcher and move around the room, doing some small things to make the patient more comfortable.
A nurse has sound, scientific evidence to support changing a procedure that would reduce catheter-related infections on the unit. The unit manager states, nevertheless, that she is unwilling to make the change because it would too costly
Which response by the nurse represents assertive communication? 1) "This is a widely used practice. If you read more research, you'd probably wonder why we aren't already doing it." 2) "There is extensive evidence to support the new method, but I don't want to create chaos." 3) "Is the budget more important to the hospital than reducing infections and patient suffering?" 4) "I'd like to help gather information regarding cost of new materials versus the savings in treating infections."
A patient has a wound that extends into the subcutaneous fatty tissue. The nurse plans care for this wound with the knowledge that it has penetrated to which skin level?
1. Epidermis 2. Hypodermis 3. Dermis 4. Cartilage
The nurse cares for a client with chronic alcohol abuse. Which laboratory finding does the nurse recognize as evidence of liver damage?
A) Albumin 3.5 g/dL B) ALT 50 unit/L C) ALP 45 unit/L D) AST/SGOT 30 unit/dL