The nurse admits a client at 2 a.m. with a history of Addison's disease. After calling the physician and receiving an order for daily cortisone, the nurse learns that the client "ran out of steroid medication two days ago
" The client says he is fine but that he feels weak. The nurse's priority action is to: 1. Wait until morning to give the ordered cortisone preparation.
2. Administer the cortisone preparation immediately.
3. Call the physician immediately and advise him of the missed cortisone.
4. Place a note on the chart for the physician to see in the morning about the missed dosages of cortisone.
3
Rationale: This client is at risk for Addisonian crisis because of the abrupt withdrawal of cortisone compounded by the stress of hospital admission. The nurse should notify the physician immediately for orders to reduce the client's risk of this life-threatening reaction. The physician might order a higher level of cortisone, so it is best not to give the ordered dosage until after notification.
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A client who has undergone resection of the intestine is on a liquid diet with a nasogastric tube in place. He refuses the food tray with regular food that comes to his room and insists that a physician be called
The nurse insists that it is the right food and makes the client to take it. The client develops complications and has to be reoperated upon. How is negligence determined in this situation? A) The nurse did not call the physician when the client asked. B) The nurse did not realize the importance of the tube. C) The dietary department sent the wrong diet for the client. D) The nurse did not communicate clearly with the client.
The nurse teaches parents to alert their healthcare provider about which adverse effect when a child receives valproic acid (Depakene) to control generalized seizures?
a. Weight loss b. Bruising c. Anorexia d. Drowsiness
A 6-year-old child is hospitalized for a surgical procedure. The parents ask if the child's four siblings can visit. Which response by the nurse is the most appropriate?
1. "Let's plan their visit for a time when the child has received pain medication." 2. "Only those siblings over 16 will be allowed to visit." 3. "I don't think the other children should visit because it might scare them to see their sibling so sick." 4. "Very young children shouldn't visit as they may carry germs."
The nurse manager is reviewing risk factors for workplace aggression and risk factors for aggression related to the psychiatric patient population. Which statement by the staff nurse indicates that teaching has been effective?
1. "Patients who are being treated for depression have an increased risk for aggression." 2. "Patients who have been diagnosed with dementia have an increased risk for aggression." 3. "Patients who are receiving group therapy for somatic symptom disorders have an increased risk for aggression." 4. "Patients who are receiving cognitive-behavioral therapy for eating disorders have an increased risk for aggression."