The nurse is assessing a 10-year-old who has just eaten lobster and has hives over much of the body. Which question would be the most important to ask the child's caregiver?
A) "Has the child ever eaten shellfish before now?"
B) "Is your child allergic to peanuts or other foods?"
C) "Does anyone in your family have any food allergies?"
D) "Have you ever given your child antihistamines?"
Ans: A
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The nurse is caring for a patient diagnosed with an arteriovenous malformation (AVM) of the ascending colon. The nurse would prepare to implement which intervention?
1. Administration of blood products 2. Administration of cytoprotective medication 3. Administration of H2 receptor blocking medication 4. Administration of antisecretory medication
A patient has a spinal cord injury at C6-T1. During his bath the nurse notes piloerection. What nursing interventions are indicated?
1. Ask the patient about the presence of a headache. 2. Ignore the occurrence and continue with the bath. 3. Determine if the patient's indwelling urinary catheter tubing is twisted. 4. Lower the head of the patient's bed. 5. Cover the exposed portions of the patient's body with a warm bath blanket.
A client with a large abdominal wound requires a dressing change every 4 hours. The client will be discharged to the home setting, where the dressing care will be continued. Which of the fol-lowing is true concerning this client's wound healing process?
1. An antiseptic agent is best followed with a rinse of sterile saline solution. 2. A heat lamp should be used every 2 hours to rid the wound area of contaminants. 3. Sterile technique should be emphasized to the client and family. 4. A dressing covering will allow the wound area to remain moist.
The nurse is teaching a client about the use of an albuterol rescue inhaler. Which nursing diagnosis is most appropriate to avoid the adverse effects of albuterol?
1. Knowledge, Deficient related to proper use of albuterol inhaler 2. Gas Exchange, Impaired related to inadequate response to albuterol 3. Airway Clearance, Ineffective related to excess mucus formation 4. Activity Intolerance related to ineffective drug therapy