The nurse writes the following on the client's chart: The client will have complete healing of the surgical incision on the right lower quadrant of the abdomen in 3 weeks. This is a(n)
A) Nursing diagnosis
B) Assessment
C) Evaluation
D) Outcome identification
Ans: D
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The nurse is caring for a patient who develops pulseless electrical activity. Upon confirmation, the nurse would immediately:
A) Start CPR B) Administer epinephrine C) Notify the physician STAT D) Start an IV of NSS wide-open rate
Which assessment finding is most important to report to the health care provider regarding a patient who has had left-sided extracorporeal shock wave lithotripsy?
a. Blood in urine b. Left flank bruising c. Left flank discomfort d. Decreased urine output
A parent of a 4-year-old is concerned that the child still wets the bed almost every night. What should the nurse respond to this parent's concerns?
A) "Disciplining will help stop this behavior." B) "Bedwetting is not uncommon in young children. Try to calmly change the bed without showing your frustration." C) "Setting rules is a parent's job to help the child have acceptable social behavior, so take away a privilege each time she wets the bed." D) "Nightly bedwetting up to age 6 or 7 is developmentally typical, so you will need to practice patience with the child."
The client comes to the emergency department after having been in the sun for an extended pe-riod of time. The nurse also determines that the client is taking a diuretic. Heatstroke is suspected and the nurse observes for:
1. Diaphoresis 2. Confusion 3. Temperature of 36? C 4. Decreased heart rate