The nurse documents a flat affect when the patient:
a. stomps on and flattens the envelope from the IRS announcing his audit.
b. goes to bed after his dog was run over.
c. laughs vigorously when his physician trips and falls.
d. receives the news of his mother's death without response.
D
Affect refers to external manifestations of inner feelings. If there is no manifestation by facial expression or verbal response, the affect is flat.
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An 18-month-old child is brought to the emergency department by his parents who explain that their child swallowed a watch battery. Radiologic studies show that the battery is in the lungs. Which area of lung is the battery most likely to be in?
A) Right upper lung B) Left upper lung C) Right lower lung D) Left lower lung
A 66-year-old native Chinese patient, hospitalized for a myocardial infarction, asks the nurse manager about seeing his "acupuncture doctor" for treatment of his migraine headache. The best response to this patient would be:
a. "How long have you been using acupuncture treatment?" b. "Do you think acupuncture relieves your pain satisfactorily?" c. "What have you told your heart specialist about your migraines and treatment?" d. "Have you tried nonprescription pain medication or been given a prescription drug for your headaches?"
An immunocompromised cancer patient has developed cryptococcal meningitis and been admitted to the intensive care unit for treatment with amphotericin B. How should the nurse most safely administer this drug?
A) Hang the drug by piggyback with lactated Ringer's and infuse over several hours to minimize the risk of infusion reaction B) Infuse the drug over 2 to 4 hours into a central line using an infusion pump C) Flush the patient's central line with normal saline and infuse the amphotericin B by intravenous push over 5 to 7 minutes. D) Place the patient on a constant infusion of amphotericin B at a rate determined by the patient's body weight.
Prior to delegating temperature measurement to assistive personnel, the nurse determines the appropriate method of measuring the client's temperature. Safety considerations include:(Select all that apply) Standard Text: Select all that apply
1. Forcing the thermometer into place to make sure it is accurate 2. Making sure the client knows not to roll over when a rectal thermometer is in place 3. Using the blue tipped thermometer for an oral temperature 4. Using a site other than oral if the client is known to have frequent seizures 5. Using probe covers except for axillary temperatures