The patient is admitted to the unit with a stage III pressure ulcer. When the different types of support surfaces are compared, which would be most therapeutic for this patient?
a. Foam mattress
b. Gel overlay
c. Air-fluidized bed
d. Air mattress
C
Air-fluidized beds are recommended for use for patients with stage III and stage IV pressure ulcers. Foam support surfaces are recommended to reduce the risk of the patient developing pressure ulcers. Gel overlay support surfaces are recommended for patients who are wheel chair dependent, as well as those who are at risk for developing pressure ulcers. Nonpowered air-filled mattress are recommended for patients who are able to reposition themselves.
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A nurse assesses a client who is prescribed fluticasone (Flovent) and notes oral lesions. Which action should the nurse take?
a. Encourage oral rinsing after fluticasone administration. b. Obtain an oral specimen for culture and sensitivity. c. Start the client on a broad-spectrum antibiotic. d. Document the finding as a known side effect.
The nurse is discussing the benefits of play therapy with the parents of a 4-year-old child. The nurse explains that play theory assists children with developing which skills? Select all that apply
1. Expressing feelings 2. Working through conflicts 3. Interrupting patterned behavior 4. Improving problem solving skills 5. Improving eye-hand coordination
At the completion of an assessment, the nurse reviews the list of a patient's stated and observed behaviors. Which of the following would indicate to the nurse that the patient is experiencing stress? Select all that apply
1. Patient stated inability to sleep more than 2 hours per night. 2. Observed patient's hands trembling. 3. Patient asked for water for a dry throat. 4. Patient sat quietly in chair, hands resting in lap. 5. Patient commented on recent pleasant weather. Correct
A male client comes to the clinic complaining of a persistent cough. Further questioning reveals that he was just recently diagnosed with hypertension. Which of the following would the nurse do next?
A) Ask how long ago he was diagnosed. B) Ask about any medications being used for hypertension. C) Refer him for further evaluation. D) Perform a complete respiratory assessment.