After suffering a fall, an 81-year-old woman with Alzheimer's disease (AD) is being treated in the hospital. Which of the following measures should be implemented in an effort to support the patient's cognitive function?
A) Maintain consistent, predictable routines whenever possible.
B) Provide an engaging, high-stimulation environment.
C) Establish clear consequences for aggressive behavior.
D) Ensure that the patient has a different care provider each day.
A
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The nurse is caring for a client using a continuous passive motion (CPM) machine and has delegated some tasks to the unlicensed assistive personnel (UAP). What action by the UAP warrants intervention by the nurse?
a. Checking to see if the machine is working b. Keeping controls in a secure place on the bed c. Placing padding in the machine per request d. Storing the CPM machine under the bed after removal
A teenager who is brought to the emergency department by the parents is reported to have taken barbiturates with alcohol. What will be the greatest concern for this patient?
1. Respiratory depression 2. Seizure activity 3. Signs of withdrawal 4. Hallucinations
The nurse palpates an older patient's lower legs and notices an indentation of approximately 4 mm left by the fingertips, which disappears in about 10 seconds. The nurse documents this edema as:
A) +1. B) +2. C) +3. D) +4.
Identify the additional assessment the nurse should make when the serum uric acid level of a 64-year-old man is 12.8 mg/dL
a. Glasgow coma scale each shift b. Heart sounds every 4 hours for murmurs and clicks c. Flank region every 12 hours for kidney tenderness d. Joints for tenderness and swelling