A nurse is assessing a pregnant client for right-sided flank pain. The nurse explains to the client that this type of pain is a common symptom of pyelonephritis in the pregnant client because of:
1. Temporary suspension of urine output.
2. Nausea and vomiting.
3. The position of the uterus in the abdomen.
4. A colicky large intestine.
3
Rationale:
1. Temporary suspension of urine output is a symptom from the pyelonephritis.
2. Nausea and vomiting are symptoms from the pyelonephritis.
3. The right side is almost always involved if the woman is pregnant because the large bulk of intestines to the left pushes the uterus to the right.
4. A colicky large intestine is an incorrect response.
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a. comparing the client's current status with the expected outcomes. b. measuring if nursing care is adequate, appropriate, and effective. c. determining if the health care agency is able to provide services needed to its client population. d. determining if the right team member is performing a specified nursing task.
After teaching a pregnant woman with iron deficiency anemia about nutrition, the nurse determines that the teaching was successful when the woman identifies which of the following as being good sources of iron in her diet? (Select all that apply.)
A) Dried fruits B) Peanut butter C) Meats D) Milk E) White bread
During a follow-up visit, the health care
provider examines the fundus of the patient's eye. Afterward, the patient asks the nurse, "Why is he looking at my eyes when I have high blood pressure? It does not make sense to me!" What is the best response by the nurse? a. "We need to monitor for drug toxicity." b. "We must watch for increased intraocular pressure." c. "The provider is assessing for visual changes that may occur with drug therapy." d. "The provider is making sure the treatment is effective over the long term."
The nurse plans a fall prevention program for a confused patient. Which task from the program is suitable for the nurse to delegate to nursing assistive personnel (NAP)?
a. Evaluating patient understanding of fall prevention plan b. Keeping the patient's bed in the low posi-tion at all times c. Assessing the patient's circulatory and respiratory status d. Instructing the patient's family about al-ternatives to restraints