When testing cranial nerve I in an elderly client who has had a head trauma, in which sequence would the nurse perform the procedure? (Prioritize sequence.)
1. hold vial with aromatic odor under the open nostril and instruct client to inspire
2. assess nose for patency by occluding one nasal wing at a time and asking client to sniff inward with the unoccluded nostril
3. have client close eyes and occlude one nostril
4. inspect the mucous membranes of the nares with an otoscope and speculum
5. have client identify aromatic odors as presented
2, 4, 3, 1, 5
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A client has a serum creatinine level of 2.5 mg/dL, a serum potassium level of 6 mmol/L, an arterial pH of 7.32, and a urine output of 250 mL/day. Which phase of acute kidney failure is the client experiencing?
a. Intrarenal b. Nonoliguric c. Oliguric d. Postrenal
The nurse is working with a client experiencing migraine headaches. When discussing possible triggers, which of the following would the nurse be least likely to include?
1. Overeating 2. Food additives 3. Peanuts 4. Caffeine
A male client 30 years of age is postoperative day 2 following a nephrectomy (kidney removal) but has not yet mobilized or dangled at the bedside. Which of the following is the nurse's best intervention in this client's care?
A) Educate the client about the benefits of early mobilization and offer to assist him. B) Respect the client's wishes to remain in his bed and ask him when he would like to begin mobilizing. C) Show the client the expected outcomes on his clinical pathway that relate to mobilization. D) Document the client's noncompliance and reiterate the consequences of delaying mobilization.
The charge nurse is assigning duties in the surgical arena. Which member of the surgical team should be assigned to the role of circulating nurse?
a. Registered nurse (RN) b. Licensed practical nurse (LPN) c. Certified surgical technologist (CST) d. Licensed nursing assistant