A client is admitted from a long-term care facility to the acute care setting. The nurse notes the client's condition in the admission assessment. Potential indicators of elder abuse include: Standard Text: Select all that apply
1. Dry, cracked lips
2. Tenting of skin when skin turgor assessed
3. Signs of kyphosis
4. Presbycusis
5. Depression
1,2,5
Rationale: Dry and cracked lips may indicate dehydration or overmedication, and should be reported to the unit supervisor
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The nurse is explaining origins of pain to several nursing students. Review the examples below, and identify the one that best describes somatic pain:
1. Second degree burn 2. Migraine headache 3. Gas pain 4. Knee sprain
According to Rubin (1975), completion of what task is paramount for a pregnant woman to master in order to have successful integration of the maternal role?
A. Incorporating the pregnancy into her total identity B. Learning to adapt to all the physiological changes C. Recognizing a "before pregnant" and "after pregnant" self D. Reorienting all relationships to put the pregnancy first
The nurse is caring for a client with advanced dementia who is refusing to cooperate with the initiation of a blood transfusion. Which action should the nurse take?
1. Consult mental health. 2. Document the treatment as refused. 3. Explain to the client why the blood is necessary. 4. Administer the blood after the client calms down.
The nurse is working hard to prevent medication errors. What interventions will assist the nurse in preventing most errors?Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
A. Always check the client's identification band prior to administration of medications. B. Open all of the medications immediately prior to administration. C. Tell healthcare providers that verbal orders will not be accepted. D. Record the medication on the medication administration record (MAR) immediately prior to administration. E. Validate all orders with another nurse prior to administration of medications.