When identifying a new client before administering medications, the nurse asks the client to state his name. The client does not give the correct name. The nurse asks again and the client states still another name. What is the nurse's next action?
A) Laugh at the client and tell him to "quit kidding."
B) Give the medications without any further questioning.
C) Investigate the client's mental status before administering any further medications.
D) Look at the client's arm band to identify the client and disregard what the client said.
Answer: C) Investigate the client's mental status before administering any further medications.
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The nurse asks, "Do your parents drink every day?" The adolescent suddenly shouts, "I'm not going to talk about that! It's none of your business, anyway! Leave me alone!"
How does the nurse interpret the adolescent's behavior? a. The adolescent is acting out and needs to be brought under control so the conference can continue. b. The adolescent is trying to shift the focus of the conference away from himself, and the nurse needs to refocus. c. The adolescent is demonstrating that this problem requires the assistance of a psychiatrist. d. The adolescent is responding to the discrediting of his parents, which causes anxiety.
An older adult client with renal failure is diagnosed with anemia. Based on this data, which cause of anemia will the nurse plan for when providing care?
A) Loss of the kidney hormone erythropoietin B) A loss of appetite related to elevated blood urea nitrogen (BUN) and creatinine levels C) The renal dialysis used to treat the chronic renal failure D) Loss of blood through the urine because the failing kidney does not function properly
The nurse working on a pediatric unit is speaking to a child who is terminally ill. The child is describing her illness in terms of mutilation to her body. Based on the child's response, the nurse plans care for which of the following?
1. Infants 2. Preschoolers 3. School-age children 4. Adolescents
One of the adverse effects of a chemotherapy drug being administered to a client is depression of pluripotent stem cells. Which change in this client's lab values would the nurse expect after treatment is initiated?
1. Decrease in red blood cells only 2. Abrupt decrease in hemoglobin and serum ferritin levels 3. Abrupt decrease in red blood cells, white cells, and platelets 4. Gradual decrease in red blood cells with a gradual increase in white blood cells