When measuring a patient's body temperature, the nurse keeps in mind that body temperature is influenced by:
a. Constipation.
b. Patient's emotional state.
c. Diurnal cycle.
d. Nocturnal cycle.
ANS: C
Normal temperature is influenced by the diurnal cycle, exercise, and age. The other responses do not influence body temperature.
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A client enters the emergency department (ED) with an injury to the wrist. In assessment, the nurse notes that the area is red, warm, and edematous. What is the nurse's best action?
a. Apply a heating pad to the area. b. Inject pain medication directly at the site. c. Start an IV infusion of a vasoconstrictive drug. d. Assess circulation and elevate the extrem-ity.
Which of the following tasks would it be appropriate for the LPN/LVN to delegate to the certified nursing assistant (CNA)?
A) Insert a Foley catheter into the postpartum client who is unable to void. B) Change the dressing for a client who had a cesarean section. C) Obtain vital signs and help the postpartum client with a sitz bath. D) Admit the newly delivered woman to the postpartum unit.
The nurse is planning care for a preterm infant. What should the nurse identify as goals for this infant's care? (Select all that apply.)
A) Accelerate growth B) Monitor fluid balance C) Preserve skin integrity D) Protect neurologic status E) Improve respiratory function