A patient who was held hostage for 12 hours by a carjacker now repeatedly states, "I can't believe it happened to me!" while admitting to feeling anxious and being afraid of strangers and of ever driving again. The nurse's interventions should target: (Select all that apply.)
a. denial.
b. anxiety.
c. confusion.
d. self-efficacy.
e. suicide potential.
A, B, D
The patient is using denial, admits to anxiety, and has self-doubts. These would be appropriate targets for intervention.
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When collecting information for a psychosocial assessment, the nurse should question which clients about a history of alcohol and drug use?
1. Clients who display unhealthy coping skills 2. All clients 3. Clients admitted with elevated drug or alcohol levels 4. Clients who have a history of substance abuse
What do blood pressure readings need to exceed for a patient to be diagnosed with hypertension?
a. 120/80 mm Hg b. 130/90 mm Hg c. 140/90 mm Hg d. 150/100 mm Hg
Cara is taking levetiracetam (Keppra) to treat seizures. Routine education for levetiracetam includes reminding her:
1. To not abruptly discontinue levetiracetam due to risk for withdrawal seizures 2. To wear sunscreen due to photosensitivity from levetiracetam 3. To get an annual eye exam while on levetiracetam 4. To report weight loss if it occurs
For adults who are unable to stand, height may be estimated by measuring
a. knee height. b. stated height. c. head circumference. d. wrist circumference.