A patient who had a bladder repair following an injury from an automobile accident complains of pain. Which action would be considered an independent nursing intervention that does not re-quire a physician's order?
a. Give an analgesic medication.
b. Apply a cold compress to the surgical site.
c. Give a muscle relaxant.
d. Irrigate the drainage tube.
B
Cold application to the surgical site is the only independent intervention.
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A nursing student has been assigned to provide care for a patient who is from a different culture and who has recently been diagnosed with cancer
After talking with the patient and her family, the student is surprised to learn that the patient wants her eldest son to make most of the decisions around her care and treatment. How should the student best respond to this situation? A) Teach the patient that she has the authority to make her own decisions while she is in the hospital. B) Speak to the son and encourage him to let his mother make decisions independently. C) Document this fact and ensure that a social worker gets involved in the patient's care. D) Understand that the members of this culture may have dynamics that differ from his or her own culture.
Place the steps of providing foot care to a diabetic client in the appropriate order. Click on the down arrow for each response in the right column and select the correct choice from the list
Response 1. Provide for privacy by pulling curtain or closing door to room. Response 2. Fill washbasin with warm water and test temperature of water. Response 3. File fingernails straight across and even with tops of toes. Use nail clippers to clip nails straight across, then shape with nail file. Response 4. Assist client to sitting position. Help bedridden client to supine position with head of bed elevated. Place disposable bath mat on floor under client's feet, or place towel on mattress. Response 5. Perform hand hygiene. Arrange equipment on over-bed table. Response 6. Help client place feet in basin. Fill basin with warm water, and soak for 10 minutes.
A young man who has had a traumatic mid-thigh amputation of his right leg refuses to look at the wound during dressing changes. Which response by the nurse is appropriate?
A) "Oh, for gosh sakes…it doesn't look that bad!" B) "I understand, but you are going to have to look someday." C) "I respect your wish not to look at it right now." D) "You won't be able to go home until you look at it."
The community health nurse is reviewing guidelines for the 15-minute assessment to keep the interview focused and family centered. Which questions and considerations for the family assessment can be asked for the question "Who is part of the family?"
(Select all that apply.) A) What is the nature of individuals' connections to one another? B) Does the individual live alone or have no living family members? C) What influences from the family of origin are present in daily life? D) Do members speak independently or is an interpreter present? E) What observations can be made about the interpersonal dynamics between members?