The nurse is performing an initial interview on a 75-year-old male. Which of the following statements by this patient indicates the need to perform a special needs assessment?
a. "I don't go to church as much as I used to but I watch the services on TV."
b. "I have fallen twice at home in the past 6 months, so my wife thinks I need a walker."
c. "I don't eat much red meat anymore but I get my protein from other foods."
d. "I had a toothache but I already saw the dentist."
ANS: B
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When a patient tells the nurse he is reluctant to report his pain because he does not want to be a bother, the nurse explains that unrelieved pain can cause which problem(s)? (Select all that apply.)
a. Increased oxygen demand b. Depression c. Respiratory dysfunction d. Decreased GI motility e. Irritability
The nurse is assessing a young adult college student who is experiencing red, swollen eyes that are oozing a yellowish drainage. The client is complaining of photophobia. Which is the most appropriate question for the nurse to ask the client?
A) "Have you had extra caffeine this week?" B) "Did you get sand in your eye recently?" C) "Have you been exposed to HIV?" D) "Have any of your friends experienced these symptoms?"
A patient is receiving a blood transfusion. 15 minutes after the beginning of the transfusion the patient begins to complain of back pain and itching. The patient is suffering from which type of hypersensitivity?
A) Anaphylactic (Type 1) B) Cytotoxic (Type II) C) Immune Complex (Type III) D) Delayed Type (Type IV)
A nurse is preparing a program for a group of parents about injury prevention. What would the nurse include as an important contributing factor for cervical spine injury in a child?
A) Exposure to teratogens while in utero B) Immaturity of the central nervous system C) Increased mobility of the spine D) Incomplete myelinization