A client arrives in the emergency department with complaints of intermittent nosebleeds over the past two days. Which are priority assessments for the nurse to implement when providing care to this client? Select all that apply.
A. Request information from the client regarding increased propensity for bruising or bleeding.
B. Obtain a blood pressure.
C. Check for deviated septum.
D. Assess the tonsils for redness or swelling.
E. Request information from the client to determine if there was any recent thin, watery drainage from the nose.
Answer: E
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A client is receiving oxygen via Venturi mask at 40%. On assessment the nurse finds the client cyanotic with labored respirations. Which action does the nurse perform first?
a. Remove bedding from around the adaptor opening. b. Listen to lung sounds and obtain a respiratory rate. c. Call respiratory therapy to check oxygen saturation. d. Notify the provider or Rapid Response Team immediately.
A nurse is wrapping up a community cultural assessment but needs to clarify some of the information learned and ask some additional questions. What is the best way to do this?
A. Internet research B. Reading old newspapers and community magazines C. Questionnaires mailed to community residents D. Hosting a focus group with several key members of the community
All hospitalized patients must be screened to determine whether they are at nutritional risk
a. if they report recent weight loss. b. if their diagnosis is nutrition-related. c. within 48 hours of hospital admission. d. within 2 weeks of hospital admission.
In comparison to pemoline (Cylert) and methylphenidate (Ritalin), atomoxetine (Strattera) may prove to:
a. be less effective in the treatment of attention-deficit disorder b. worsen depression and cause suicidal ideation c. have less potential for abuse in susceptible individuals d. be more sedating and cause weight gain