The home care nurse reviews the client and family's socioeconomic status, cultural aspects, and beliefs. This occurs during which phase of care?
A) Assessment
B) Nursing diagnosis
C) Outcome criteria
D) Implementation
Ans: A
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A patient's fluid overload has required several doses of furosemide (Lasix). Which medication will be administered if the patient's serum potassium level is 2.8 mEq/L?
A) Potassium chloride B) Calcium gluconate C) Potassium carbonate D) Sodium polystyrene sulfonate (Kayexalate)
After undergoing dural puncture while receiving epidural pain medication, a patient complains of a headache. Which action can help alleviate the patient's pain?
1) Encourage the client to ambulate to promote flow of spinal fluid. 2) Offer caffeinated beverages to constrict blood vessels in his head. 3) Encourage coughing and deep breathing to increase CSF pressure. 4) Restrict oral fluid intake to prevent excess spinal pressure.
A toddler who has just been admitted to the pediatric unit is crying and scared. No treatment has been initiated at this point. The nurse needs to start an IV and the parent asks, "Will this be painful to my child?"
In practicing veracity, the nurse responds: 1. "I won't lie to you. It may be easier for you if you step out until we get the line in." 2. "We'll take every care not to hurt your child." 3. "It shouldn't be too bad and I'll be quick." 4. "We do this all the time, so don't worry."
The nurse reviews the ways to prevent condom breakage with a patient. Which patient statement indicates that more teaching is necessary?
a. "Condoms should never be reused." b. "I should use a water-soluble lubricant." c. "Before I use a condom, I should inflate it and check it for holes and leaks." d. "I should make sure to leave a half inch extra space at the end of the condom."