While caring for an 88-year-old client suspected of having dementia, the nurse should assess the client for a common delusional thought expressed as:
A) "I am the king of the universe."
B) "Creatures are living in my closet."
C) "The government has people following me."
D) "My roommate keeps stealing my clothes."
D
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A nurse caring for a 68-year-old patient diagnosed with mycoplasmal pneumonia observes that the patient has difficulty breathing due to copious tracheobronchial secretions. The patient should be encouraged to do which of the following?
A) Increase oral fluids unless contraindicated. B) Call the nurse for deep suctioning. C) Lie in a low-Fowler's position. D) Increase activity.
After giving two breaths to an adult client who is not breathing, the rescuer should assess the client for:
a. return of consciousness c. strength of carotid pulse b. rise and fall of the chest d. tolerance of rescue breathing
A 32-year-old male victim of a motor vehicle accident is identified as a potential organ donor based upon his identification on his driver's license. The nurse should contact the
A) authorities of the state motor vehicle license office. B) ethics committee of the hospital. C) local organ procurement organization. D) American Medical Association.
The client has received a dose of nitroprusside sodium to treat hypertensive crisis. She complains to the nurse of experiencing abdominal pain and nausea
The highest priority action on the part of the nurse is to call the physician because this is ________ the medication. a. an expected side effect of the b. an adverse reaction to c. evidence of a toxic level of the d. evidence of an anaphylactic reaction to