The nurse is caring for four patients in a medical-surgical unit. Which patient should the nurse see first?
1. A patent admitted with pneumonia who is has small amounts of yellow productive sputum
2. A patent admitted with fever of unknown origin whose temperature is currently 99.0?F
3. A patent admitted with an infected wound on the left foot whose WBC is 8,500 mm3
4. A patent admitted with infectious gastroenteritis who has had severe diarrhea for the last 24 hours
4
Rationale 1: Small amounts of yellow productive sputum are expected in a patient with pneumonia.
Rationale 2: A patient admitted with a fever whose temperature is currently 99°F is not in acute distress.
Rationale 3: The patient with the infected leg wound currently has a white blood cell count within normal limits.
Rationale 4: This patient is at risk for dehydration and could experience a fluid-volume deficit.
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A male nurse is enjoying a very hot summer day at the zoo when he notices a family approaching. An elderly member of the family is moving very slowly and being scolded by another adult, saying "You are not sick. Let's keep moving." The nurse touches the elderly adult who has a flushed face and notices clammy and moist skin. What should the nurse say to the adult?
a. "I'm a nurse, and your family member needs to go to the emergency department right now." b. "I'm a nurse, and your family member has heat stroke. I'm calling 911." c. "Take your family member to the air-conditioned restaurant, and have him drink a cold soda immediately." d. "Take your family member to the air-conditioned restaurant, and let your family rest for a while."
A nurse is caring for a new mother from Southeast Asia. The nurse is concerned that except for breastfeeding, the mother allows her mother-in-law to provide all other care for the baby. The plan of care and patient teaching for this mother should include
a. assessing the postpartum practices in her country of origin. b. assuming that the mother-in-law will care for the baby well since she is experienced. c. completing the teaching outlined for new mothers. d. asking the mother-in-law not to care for the baby so that the mother learns the care.
A unit in the hospital has just ended an emergency situation in which the client survived. The nurses are breaking for lunch and plan to process their feelings about the emergency. The best way to accomplish this would be:
1. Talk while riding in the staff elevator. 2. Ask management for the use of a conference room. 3. Discuss the event outside the hospital. 4. Talk about the situation at home.
The patient is receiving an oral antibiotic as treatment for cellulitis of the lower extremity. The patient's outcome is "Patient will state a key point about antibiotic treatment for cellulitis."
Which statement by the patient provides the best evaluation by the nurse at this time? 1. "If the pain gets too bad, I can take my prescribed pain medication." 2. "If the swelling continues, I can apply an ice pack." 3. "I need to take all the pills even if my leg looks better." 4. "I must keep my leg elevated until the swelling goes down."