The nurse is taking a few hours over the weekend to perform a self-evaluation of health practices. On what will the nurse focus during this evaluation? (Select all that apply.)
A) Corrective actions to improve rest
B) Relationships with family members
C) Feelings about friends and interests
D) Signs of unhealthy respiratory habit
E) Contributing factors to unhealthy movement
A, D, E
Feedback:
A periodic "checkup" of physical status can help disclose problems that impact the ability to provide care to patients and threaten personal health and well-being. During this time, the nurse would focus on ways to improve rest, respirations, and movement. Relationships with family members and feelings about friends and interests would be possible topics to include when telling a life story.
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A client with a history of rheumatic heart disease is being evaluated for mitral stenosis. To identify symptoms that support the diagnosis of mitral stenosis, the nurse should ask which question?
1. "How often do you get short of breath?" 2. "Have you had a lot of headaches recently?" 3. "Do you experience numbness or tingling in your extremities?" 4. "Do you have to urinate often during the night?"
The nurse comes across a group (four individuals) overcome by a toxic gas substance and unconscious. Place the nursing action in order of what the nurse would do first? (Use all options.)
A) Eliminate the source of the toxic gas. B) Begin first aid or supportive measures. C) Assess the clients for spontaneous breathing. D) Call 911 for emergency assistance. E) Move the clients to fresh air.
A client with diabetes comes to the clinic for a follow-up visit. The nurse reviews the client's glycosylated hemoglobin test results. Which result would indicate to the nurse that the client's blood glucose level has been well controlled?
A) 6.5% B) 7.5% C) 8.0% D) 8.5%
The nurse is assessing extraocular eye movements (EOMs) in an older adult client and finds that the client is unable to sustain an upward gaze for longer than 2 seconds. What does the nurse do next?
a. Repeat the test while holding the client's head in a fixed position. b. Perform a cover-uncover eye test. c. Document the finding and continue as-sessing. d. Assess for additional signs of impending brain attack.