The caregiver of a child with a recent puncture wound is
concerned because the child has a fever, pain at the site of the injury, and is unable to bend the joint of the injured extremity. What needs to be done before determining the care that this child needs?
A) An x-ray
B) A muscle biopsy
C) Blood work
D) A surgical consult
Ans: C
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The nurse examines the newborn's tonic neck reflex, turning the head to the right side while lying supine, and determines that the reflex is intact when the infant:
1. Flexes the left arm and leg. 2. Makes a stepping motion with the feet. 3. Curls the toes as if trying to grasp with the feet. 4. Begins a sucking motion.
The nurse expects the patient diagnosed with polycythemia vera to display which of the following manifestations of the disease?
A) Elevated red blood cells and splenomegaly B) Lowered hematocrit and splenomegaly C) Lowered hematocrit and jaundice D) Elevated red blood cells and jaundice
An important action the nurse can take that will most likely increase client compliance with a sodium- and fat-restricted diet is to
a. offer to find the client a class on heart-healthy cooking. b. provide verbal education on ways to modify the client's current diet. c. refer the client for a consultation with a registered dietitian. d. tell the client about complications that may occur from not being compliant.
A nurse applies a cooling blanket to a patient with a temperature of 10E.4°F. The nurse would recognize which of the following as an indication of therapeutic effectiveness?
1. The patient begins to shiver. 2. The blood pressure and pulse increase. 3. The temperature slowly falls to 100°F. 4. The level of consciousness decreases.