The nurse is caring for a client who is experiencing metabolic alkalosis. The nurse plans to protect the client's safety, knowing the risks of this imbalance, by carefully implementing which of the following prescribed precautions?
1. Contact isolation
2. Seizure precautions
3. Bleeding precautions
4. Neutropenic precautions
2
Rationale: The client with metabolic alkalosis is at risk for tetany and seizures. The nurse would maintain client safety by using seizure precautions with this client. "Contact isolation," "bleeding precautions," and "neutropenic precautions" are unnecessary in the care of the client experiencing metabolic alkalosis.
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A patient with pericarditis has just been admitted to the CCU. The nurse planning the patient's care should prioritize what nursing diagnosis?
A) Anxiety related to pericarditis B) Acute pain related to pericarditis C) Ineffective tissue perfusion related to pericarditis D) Ineffective breathing pattern related to pericarditis
The nurse includes interventions to improve impaired physical activity in the plan of care for the older resident. Which of the following interventions should the nurse include? (Select all that apply.)
A) Develop an exercise program that promotes maximum heart rate. B) Encourage family to assist in efforts to increase the patient's mobility. C) Include passive range of motion (PROM) in plan. D) Promote a nutritional intake of calcium and protein. E) Provide diversional activities based on the patient's interests and level of function.
A client, pregnant for the first time and in the first trimester says, "I don't know how much longer I can stand this nausea and feeling so tired." Which of the following learning needs should the nurse address first?
a. Need for daily vitamins b. Infant care c. Labor and delivery d. Methods to cope with nausea
The nurse and a client talk about healthy ways to meet needs. The client states, "When I am looking really good, it is not asking too much for people to acknowledge me.". The nurse recognizes that teaching should be directed toward:
A) A sense of entitlement. B) Feelings of emptiness. C) Affective instability. D) Splitting.