In a report, a nurse learns that a client has a macular rash and expects to find:
a. Elevated, firm, well-defined lesions less than 1 cm in diameter.
b. Depressed, firm, or scaly, rough lesions greater than 1 cm in diameter.
c. Elevated, fluid-filled lesions less than 1 cm in diameter.
d. Flat, well-defined, small lesions less than 1 cm in diameter.
ANS: D
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A patient with liver disease has developed jaundice; the nurse is collaborating with the patient to develop a nutritional plan. The nurse should prioritize which of the following in the patient's plan?
A) Increased potassium intake B) Fluid restriction to 2 L per day C) Reduction in sodium intake D) High-protein, low-fat diet
The nurse working on a high-acuity medical-surgical unit is prioritizing care for four patients who were just admitted. Which patient should the nurse assess first?
a. The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30 Novolin insulin b. The patient with a pulse of 58 beats per minute who is about to receive digoxin [Lanoxin] c. The patient with a blood pressure of 136/92 mm Hg who complains of having a headache d. The patient with an allergy to penicillin who is receiving an infusion of vancomy-cin [Vancocin]
The nurse tells the patient that he will stay until the physician is back with the results of the diagnostic tests. This is an example of which communication technique?
A) using focused comments B) providing general leads C) validating D) offering self
The nurse observes that a client with bipolar disorder is pacing in the hall, talking loudly and rapidly, and using elaborate hand gestures. The nurse concludes that the client is demonstrating which of the following?
a. Aggression b. Anger c. Anxiety d. Psychomotor agitation