When monitoring the client 2 hours after he has had a thoracentesis, you note that the skin around the puncture site is swollen and crackles when pressure is applied. What is your next action?
A. Document the finding as the only action.
B. Obtain a culture from the site.
C. Reinforce the dressing.
D. Notify the physician.
D
The swelling and crackling are indications of subcutaneous emphysema.
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A 13-year-old girl tells the school nurse that she is getting fat, especially in her hips and legs. What understanding by the nurse would best guide the response?
a. Many adolescents are unaware of proper nutrition. b. Adolescents of this age become less active and should eat fewer calories. c. Puberty is often preceded by fat deposits in these areas. d. As soon as menarche occurs, she will lose this excess weight.
The ABCs of rational-emotive therapy (RET) are:
A. Acting, believing, concise. B. Able, belief, consequences. C. Activating, belief, consequence. D. Awareness, believing, conclusions.
The nurse is counseling with a client who has atropic dermatitis (eczema) and has developed a secondary Staphylococcus aureus infection. To prevent this type of infection from reoccurring in the future, the nurse should stress:
1. Methods to prevent itching. 2. Continuous antibiotic treatment. 3. Frequent bathing. 4. Allergy testing.
Which of the following programs demonstrates the use of tertiary prevention?
a. Developing an in-school clinic that provides birth control counseling and contraception b. Providing a diabetes management program for persons with diabetes mellitus c. Providing cardiovascular fitness evaluations at annual health fairs d. Setting up free blood pressure screenings at popular department stores and supermarkets