A patient with bipolar disorder has taken lamotrigine (Lamictal) for 3 months with an excellent response. Which complaint from the patient necessitates the nurse's priority attention?
a. "I have a rash on my chest and abdomen.".
b. "I experience occasional nausea.".
c. "I have a little hand tremor.".
d. "My nose is stuffy.".
A
The symptoms listed in the correct response suggest a potential life-threatening dermatological reaction and warrant immediate intervention. All other problems mentioned are unrelated to problems with this drug.
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The charge nurse is planning vital sign assignments for the unlicensed assistive personnel (UAP) on a busy medical-surgical unit. Which patients are appropriate for the UAP to obtain vital signs? (Select all that apply.)
a. A 28-year old patient scheduled to be discharged home today b. A 49-year-old patient with stable chronic lung disease c. A 78-year-old patient with recent onset of rectal bleeding d. A 35-year-old patient waiting for transfer to a rehabilitation center e. A 40-year-old patient being admitted from the emergency department
A 7 pound 14 ounce girl was born to an insulin-dependent type II diabetic mother 2 hours ago. The infant's blood sugar is 47 mg/dL. What is the best nursing action?
1. To recheck the blood sugar in 6 hours 2. To begin an IV of 10% dextrose 3. To feed the baby 1 ounce of formula 4. To document the findings in the chart
A client is diagnosed with a benign lung tumor. Which of the following is a characteristic of this disorder?
A) Benign tumors usually cause fatigue, weight loss, and chest pains. B) Lung scan confirms an abnormal shadow in the lung. C) Smoking is the usual cause of a benign lung tumor. D) Lung tumors are characterized on x-rays with smooth edges and sharp margins.
What is the rule for analyzing evaluation data?
A. Before making any recommendations, interpretation and judgment are necessary. B. Following historical precedent of the agency in its use of evaluation data is the wisest approach. C. Review the literature and try to be consistent with what others in community health are doing. D. The nurse should use the Omaha System because it is the most helpful and most commonly used system.