The nurse is caring for four clients. The client with the greatest risk of developing retinopathy of prematurity is the:
1. 30-weeks'-gestation infant who was in an oxyhood for 12 hours and weighed 1,800 grams.
2. 32-weeks'-gestation infant who needed no oxygen and weighed 1,850 grams.
3. 28-weeks'-gestation infant who has been on long-term oxygen and weighed 1,400 grams.
4. 28-weeks'-gestation infant who was on short-term oxygen and weighed 1,420 grams.
3
Rationale:
1. The 30-weeks'-gestation infant was on oxygen for short period of time.
2. The 32-weeks'-gestation infant was not placed on oxygen, and therefore is not at risk.
3. The 28-weeks'-gestation infant on oxygen weighing 1,400 grams has the greatest risk of retinopathy of prematurity because of gestational age (28 weeks or less), weight (less than 1,500 g), and oxygen therapy.
4. The 28-weeks'-gestation infant was only placed on short-term oxygen.
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The nurse is performing percussion during an abdominal assessment. Percussion notes heard during the abdominal assessment may include:
a. Flatness, resonance, and dullness. b. Resonance, dullness, and tympany. c. Tympany, hyperresonance, and dullness. d. Resonance, hyperresonance, and flatness.
The identification of a disease or condition by a scientific evaluation of physical signs, symptoms, history, laboratory tests, and procedures is known as a _________ _______
ANS:
Which can the nurse safely delegate to the unlicensed assistive personnel (UAP)?
1. Initial assessment of pain 2. Regular reassessment of pain 3. Providing a massage and repositioning the client in pain 4. Administration of an oral analgesic
An older woman has just had surgery to repair a fractured hip. Identify the care settings, ordering from least to most client autonomy, that the woman may encounter
A. Transitional care unit (TCU) B. Skilled nursing facility (SNF) C. Inpatient orthopedic unit D. Independent living in her own home E. Assisted-living facility (ALF)