The nurse is caring for a client on the client's first postoperative day. The client has a midline abdominal incision; is febrile; has coarse crackles throughout lung fields; and refuses to turn, cough, or breathe deeply
Which of the following nursing diagnoses is most appropriate?
1. Activity intolerance related to hypoxemia
2. Excess fluid volume related to fluid in lungs
3. Fatigue related to increased work of breathing
4. Ineffective airway clearance related to pain and inability to cough
ANS: 4
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Which statement indicates that client teaching about vaginal infections has been effective?
1. "The fishy vaginal odor I have is caused by a bacterial infection." 2. "I can use this antiyeast medication weekly to prevent another infection." 3. "My diabetes is unrelated to the frequency of my vaginal yeast infections." 4. "I should douche weekly to prevent a recurrence of my bacterial vaginosis."
During the care of a preoperative patient, the nurse has given the patient a preoperative benzodiazepine. The patient is now requesting to void. What action should the nurse take?
A) Assist the patient to the bathroom. B) Offer the patient a bedpan or urinal. C) Wait until the patient gets to the operating room and is catheterized. D) Have the patient go to the bathroom.
The transplant clinic social worker is completing a social history on a patient with end-stage renal disease who is being evaluated for transplant. Which statement by the patient warrants further action?
a. "I only smoke marijuana on an occasional basis." b. "I have two sisters who live within two hours of me." c. "I have attended all of my scheduled dialysis sessions." d. "My mother's side of the family has a history of cancer."
The nurse can be proactive in reducing neurologic injuries by: (Select all that apply.)
a. insisting everyone "buckle up" before starting the car. b. encouraging children to wear bike helmets. c. reminding swimmers to test water depth before diving. d. encouraging use of hard hats at industrial sites. e. discouraging recreational drug use that could bring on a stroke.