The nurse suspects a client, recovering from hip replacement surgery, is experiencing an infection when which of the following is assessed?
1. Client using crutches to ambulate
2. Blood pressure 110/68 mmHg
3. Pain with movement
4. Foot intact to sensation and motion
3
Evidence of an infection in the joint of a client recovering from hip replacement surgery includes erythema, edema, drainage, and tenderness over the joint; persistent pain in the joint with movement; and narrowing of the joint space upon x-ray. Using crutches to ambulate would not indicate an infection in the operative site. A blood pressure of 110/68 mmHg is within normal limits. The foot being intact to sensation and motion would indicate the limb is receiving sufficient blood and oxygenation.
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The nurse instructed an adolescent female about collecting a clean-catch urine specimen. What statement made by the adolescent led the nurse to determine she understood the instructions?
a. "I should wash my perineum with soap and water, then begin to urinate." b. "I clean the perineum from front to back with an antiseptic wipe before I urinate." c. "I'll collect the first stream of urine in a sterile container." d. "I will discard the first void and collect a freshly voided specimen 30 minutes later."
When paramedics notice singed hairs in the nose of a burn patient, it is recommended that the patient be intubated. What is the reasoning for the immediate intubation?
a. Carbon monoxide poisoning always occurs when soot is visible. b. Inhalation injury above the glottis may cause significant edema that obstructs the airway. c. The patient will have a copious amount of mucus that will need to be suctioned. d. The singed hairs and soot in the nostrils will cause dysfunction of cilia in the airways.
A couple comes in for an infertility workup, having attempted to get pregnant for 2 years. The woman, 37, has always had irregular menstrual cycles but is otherwise healthy
The man has fathered two children from a previous marriage and had a vasectomy reversal 2 years ago. The man has had two normal semen analyses, but the sperm seem to be clumped together. What additional test is needed? a. Testicular biopsy b. Antisperm antibodies c. Follicle-stimulating hormone (FSH) level d. Examination for testicular infection
The nurse is planning to attend a program to learn how to respond to mass casualty incidents
The nurse anticipates this program will address which core competencies of emergency and disaster preparedness for nurses? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Creative problem-solving skills 2. Adherence to standard protocols and policies 3. Emergency communication skills 4. Understanding of personal limitations 5. Identification of emergency situations