The nurse is likely to determine mobility and health status as a safety concern in which of the following clients? Standard Text: Select all that apply
1. A post-operative client on narcotic analgesics
2. A client who is illiterate
3. A client with an arm cast
4. An elderly client
5. The client with a spinal cord injury
1,4,5
Rationale 1: Clients using mind-altering medications are at risk for injury because of lack of coordination or impaired judgment.
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Which of the following statements indicates that a client has taken self-care measures to reduce her risk for cervical cancer?
A) "I've really cut down on the amount of caffeine I drink everyday." B) "I've thrown out all my bubble baths and just use soap and water now." C) "Every time I have sexual intercourse, I'm sure to douche." D) "My partner always uses a condom when we have sexual intercourse."
In addition to monitoring vital signs, the nursing care priority during the fourth stage of labor is to:
a. allow the mother to bond with her infant and begin breastfeeding b. assess uterine tone and the amount of vaginal bleeding c. assist the mother to void or catheterize her d. keep an ice pack on the perineum or episiotomy
The nurse is caring for a patient experiencing shock who is taking Atenolol (Tenormin). Which of the following symptoms of shock would be expected to be present in this patient? (Select all that apply.)
a. Pulse 115 beats per minute b. Respirations 28 per minute c. Blood pressure 88/48 mm Hg d. Capillary refill greater than 3 seconds
Which client receiving typical antipsychotic medication would be assessed as displaying behav-iors characteristic of tardive dyskinesia? The individual who:
1. Grimaces and smacks her lips 2. Falls asleep in her chair and refuses to eat lunch 3. Is experiencing muscle rigidity and tremors 4. Has excessive salivation and drooling