If a client shows intolerance to light during pupil examination, the nurse would record that the client exhibits
a. photophobia.
b. reduced accommodation.
c. strabismus.
d. unequal pupil response.
A
Abnormal results include photophobia (light intolerance), irregular or unequal pupils, and pupils that do not react to light or accommodation. Strabismus is deviation in the alignment of one eye in relation to the other; it often presents as crossed eyes.
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The most important assessment of neurovascular status to make after spinal surgical instrumentation would be to
A) check the nailbeds of the fingers for capillary refill. B) determine the presence of brachial pulses. C) assess the legs for warmth. D) ask if the child has pain.
A nurse is planning a health program. Which of the following is the most critical action that should be taken by the nurse?
a. Assessing need of the community b. Considering alternative solutions or op-tions c. Detailing the costs and resources needed d. Weighing each alternative
The nurse uses a systematic method for collecting data on all body systems, including normal functioning and any noted changes. What is this method?
a. Nursing interview b. Review of systems c. Nursing assessment d. Health history
A 47-year-old man with no confusion, BUN = 17 mg/dL, respiratory rate = 32/min; and blood pressure = 110/72 mm Hg. Based on the CURB-65 criteria, indicate whether the patient should be treated as an inpatient or outpatient.
A. Inpatient B. Outpatient