The nurse notes that a trauma patient has multiple tangles in the hair. Which of the following actions taken by the nurse is appropriate? (Select all that apply.)
a. Work the tangles to the ends of the hair, then trim with scissors.
b. Apply warm water and conditioner.
c. Apply detangler as available.
d. Use a comb or fingers to work through tangles.
ANS: B, C, D
Apply warm water and a conditioner or a detangler, if available, to release tangles and avoid injury to the scalp. Use a comb and/or fingers to work through the tangles individually before shampooing. The nurse avoids cutting the patient's hair unless first asking the patient's permission.
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While working in a pediatric clinic, the nurse cares for a 2-year-old with a diagnosis of impetigo. The nurse teaches the mother how to care for the child, and determines further teaching is needed when the mother states:
1. "I will wash the sore with mild soap to remove crusts." 2. "I will apply bacitracin to the wound and cover it with a bandage." 3. "I will watch the wound carefully and call the doctor if it feels hot." 4. "I will call the doctor if the wound doesn't improve, or gets bigger."
When instructing the patient taking an oral liquid iron preparation, what should the nurse include?
a. Information relative to taking the iron with milk b. Information relative to the bowel movement color changing to dark red c. Information relative to taking preparation through a straw to prevent staining of teeth d. Information relative to taking a drug with meals or a snack
What nursing action should be implemented when dealing with a patient who is an alcoholic in denial and claims to only drink in social situations?
a. Insist that he stop drinking entirely. b. Point out that the patient is using denial. c. Help the patient investigate ways to re-duce drinking. d. Provide information on Alcoholics Ano-nymous.
When using a refillable ice bag, a nurse correctly
1. Fills the bag one-half to two-thirds with ice and some water. 2. Fills the bag completely with water and then freezes it. 3. Fills the bag completely with ice. 4. Fills the bag one-quarter to one-third with ice and then partially melts the ice in the microwave.