Which nursing intervention would you use to prevent injury in the client receiving oxygen therapy by continuous nasal cannula?
A. Providing mouth care every 8 hours
B. Lubricating the lips with water-soluble jelly
C. Draining the condensation in the tubing every 2 hours
D. Changing the position of the elastic band every 4 hours
D
Clients receiving oxygen by nasal cannula are prone to skin breakdown on the ears, back of the neck, and face.
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The nurse is caring for a postoperative patient who needs daily dressing changes. The patient is 3 days post-op and should be going home the next day
Up until now, the patient has refused to learn how to change her dressing. What would indicate to the nurse the patient's readiness to learn how to change her dressing? (Mark all that apply.) A) The patient wants you to teach a family member to do dressing changes. B) The patient expresses interest in the dressing change. C) The patient looks at the incision. D) The patient expresses dislike of the surgical wound. E) The patient assists in opening the packages of dressing material for the nurse.
A patient is suspected of having macular degeneration. During the assessment the patient is asked to focus on an image. What evidence will support the diagnosis?
a. The patient only sees disconnected pieces of the image. b. The patient sees a dark spot in center of what is viewed. c. The patient sees nothing in the peripheral vision. d. The patient sees wavy lines and bright flashing lights.
Immediately after the nurse administers an intracutaneous injection of an allergen on the forearm, a patient complains of itching at the site and of weakness and dizziness. What action should the nurse take first?
a. Remind the patient to remain calm. b. Administer subcutaneous epinephrine. c. Apply a tourniquet above the injection site. d. Rub a local antiinflammatory cream on the site.
Which of the following prevention activities would be considered primary prevention?
1. Urine screening for pesticide exposure 2. TB skin testing 3. Treatment of lead poisoning 4. Reduction of pesticide exposure