When collecting objective data on a 3-year-old child, which action by the nurse would be the most appropriate?
A) Tell the caregiver it would be best for her to fill out the paperwork outside the room while the nurse is measuring the child's height and weight
B) Take the child to another room to measure the child's vital signs
C) Perform a head-to-toe assessment on the child starting with the eyes, ears, and nose
D) Show the caregiver the process for collecting a urine specimen and asks her to help the child
Ans: D
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A woman who is 25 weeks pregnant asks the nurse what her fetus looks like. What does the nurse explain is one physical characteristic present in a 25-week-old fetus?
a. Lanugo covering the body b. Constant motion c. Skin that is pink and smooth d. Eyes that are closed
The hospital policy and procedure manual states that medications should be charted immediately after administration. The nurse routinely charts the medications as they are being prepared for administration. What does this practice reflect?
1. An honest error in judgment 2. A violation of hospital policy and procedure 3. Use of the two schools of thought doctrine 4. Logical and appropriate variation in practice
A student is reading the medical record of an assigned patient and notes the patient has been afebrile for the past 12 hours. What does the term "afebrile" indicate?
A) normal body temperature C) increased body temperature B) decreased body temperature D) fluctuating body temperature
The nurse is teaching a client about the need for supplemental thyroid hormone following a hypophysectomy because of an anterior pituitary adenoma. The client says, "I thought thyroid hormone came from a gland in my neck."
Which follow-up statement by the nurse is most appropriate? 1. "Your thyroid gland no longer gets messages from the pituitary." 2. "You will only need to take thyroid hormone until healing occurs." 3. "You need this hormone because your TSH is too high since surgery." 4. "Your thyroid gland was damaged because of the long surgical procedure."