The nurse admits an elderly woman with a diagnosis of osteoporosis. The nurse plans which intervention to prevent complications related to this diagnosis?
1. Pad the side rails of the bed to prevent fractures.
2. Encourage a moderate exercise program to reduce bone loss.
3. Administer analgesics for pain.
4. Obtain an order from the physician for vitamin K supplements.
2
Rationale: The best intervention for this client is to encourage a moderate regular exercise program, such as walking, to reduce the loss of bone mass. While bones become increasingly fragile with osteoporosis, they do not become so fragile as to require side rail padding. The need for analgesics is not indicated, and is not inherent with the diagnosis of osteoporosis. Vitamin D, calcium, and phosphorous supplementation, not vitamin K supplementation, is useful in treating and preventing further bone loss related to osteoporosis.
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When maintaining medical records for a client, the nurse knows that a medical record also serves as legally admissible evidence. What should the nurse do to ensure legally defensible charting?
A) Ensure that the client's name appears on all pages. B) Leave spaces between entries and signature. C) Use abbreviations wherever possible. D) Record all facts and subjective interpretations.
Identify the task that may be delegated to an LPN (LVN) if all the clients are stable
a. Adding potassium to a bag of D5W that was already hanging b. Developing the nursing diagnosis for a newly admitted client c. Teaching a new diabetic patient how to administer insulin injections d. Turning a client with a CVA every 2 hours
During the termination phase, a client begins to raise old problems that have already been resolved. Which of the following would be the most appropriate nursing response? Select all that apply
A) Immediately stop the client and inform them that the nurse is running the session. B) Get angry at the client and ask them to leave the session. C) Reassure the client that they already covered these issues. D) Review with the client the learned methods to control the problems. E) Do not acknowledge this issue and continue on with the session as planned.
Which of the following is a responsibility of the nursing assistant in preoperative care?
A. Encourage the patient to pick out clothing to wear preoperatively for the patient's own comfort. B. Hold all of the patient's valuables in your uniform pocket to keep safe during surgery. C. Encourage the patient to use the bathroom. D. Help the patient do the patient's hair and makeup, to promote self-esteem.