A client has just arrived to the Emergency Department and has sustained burns on the front and back of the right arm and leg. Using the rule of 9s, what is the body surface area percentage?
A) 27%
B) 18%
C) 36%
D) 9%
Ans: A) 27%
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A telehealth nurse speaks with a client who is recovering from a liver transplant 2 weeks ago. The client states, "I am experiencing right flank pain and have a temperature of 101 ° F." How should the nurse respond?
a. "The anti-rejection drugs you are taking make you susceptible to infection." b. "You should go to the hospital immediately to have your new liver checked out." c. "You should take an additional dose of cyclosporine today." d. "Take acetaminophen (Tylenol) every 4 hours until you feel better."
The patient, newly diagnosed with diabetic retinopathy, asks what caused this disorder. What is the nurse's best response?
A) Inability of cells in the eye to reproduce B) Increase of aqueous humor in the eye C) Decrease of nerve innervations throughout the eye D) Oxygen cannot diffuse rapidly across the membrane to tissues in the eye
When caring for a client at a health care facility, the nurse discovers that the client is unable to read or write. Which of the following teaching approaches is most useful for the client?
A) Teach the client basic reading and writing. B) Use verbal and visual presentation modes. C) Keep the teaching sessions short. D) Involve the client in an active way.
Goals and expected outcomes should meet specific if included in the concept map or care plan. Which of the following would be documented when writing goals or expected outcomes?
a. nurse specific b. both the goals and expected outcomes should be measurable c. time specific d. history of present illness