When palpating the axillae, which finding would the nurse document as normal?
A) Node size: 1.2 cm
B) Fixed
C) Hard
D) Discrete
D
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A nurse assesses a client who is hospitalized for botulism. The client's vital signs are temperature: 99.8 ° F (37.6 ° C), heart rate: 100 beats/min, respiratory rate: 10 breaths/min, and blood pressure: 100/62 mm Hg. Which action should the nurse take?
a. Decrease stimulation and allow the client to rest. b. Stay with the client while another nurse calls the provider. c. Increase the client's intravenous fluid replacement rate. d. Check the client's blood glucose and administer orange juice.
A client has ventilator settings as follows: SIMV 16, PEEP 20 cm of H2O, FiO2 45%, tidal volume .450 liters. What concerns will the nurse have for this client?
1. Barotrauma 2. Volutrauma 3. Sinusitis 4. Oxygen toxicity
Select the best response for the nurse who receives a question from another health professional seeking to understand the difference between a Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnosis and a nursing diagnosis
a. "There is no functional difference between the two. Both identify human disorders." b. "The DSM-5 diagnosis disregards culture, whereas the nursing diagnosis takes culture into account. c. The DSM-5 diagnosis describes causes of disorders whereas a nursing diagnosis does not explore etiology." d. "The DSM-5 diagnosis guides medical treatment, whereas the nursing diagnosis offers a framework for identifying interventions for issues a patient is experiencing."
What normal finding does a nurse expect to find when palpating a male patient's prostate gland?
a. Is approximately 4.5 cm in diameter and is highly mobile b. Feels smooth, firm, and slightly mobile c. Is deeply divided into three lobes, each approximately 2 cm in length d. Feels hard, asymmetrical, and has a palpable ridge that divides the gland into two lobes