A nurse is caring for a client who has a spinal cord injury and develops signs of autonomic dysreflexia. Which action should the nurse take immediately?
a. Assess the client's blood pressure every few minutes until within normal limits.
b. Assess the client's respiratory function, and institute intubation procedures, if necessary.
c. Place client flat in bed.
d. Administer client's prescribed analgesic.
A
As the recovery and rehabilitation process continues, the nurse continues to monitor the client's physiologic parameters, including bowel and bladder function, skin condition, and evidence of complications such as neurogenic shock and autonomic dysreflexia.
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A Filipino-American patient had this nursing diagnosis: Situational low self-esteem, related to poor social skills as evidenced by lack of eye contact. Interventions were used to raise the patient's self-esteem;
however, after 3 weeks, the patient's eye contact did not improve. What is the most accurate analysis of this scenario? a. The patient's eye contact should have been directly addressed by role-playing to increase comfort with eye contact. b. The nurse should not have independently embarked on assessment, diagnosis, and planning for this patient. c. The patient's poor eye contact is indicative of anger and hostility that remain unaddressed. d. The nurse should have assessed the patient's culture before making this diagnosis and plan.
A nurse has made plans to implement the University of North Carolina (UNC) model of "5 As" during the process of applying evidence-based practice (EBP) to a practice problem. What is the final step that the nurse will take in applying this model?
A) Analyze the results of the EBP process B) Advocate for others to embrace the identified change C) Adopt the changes identified in the review process D) Assess the outcomes of the new practice
Population-based preventive programs launched in the 1970s are responsible for all of the following except
1. Changes in tobacco use 2. Automobile safety restraints 3. Dietary patterns and blood pressure control 4. Decrease in obesity rates
A client comes to the women's center and tells the nurse she has had unprotected sex. She asks for emergency contraception. What is the best assessment question for the nurse to ask?
1. "How long ago did you have unprotected sex?" 2. "Did you use a condom?" 3. "What kind of birth control have you used in the past?" 4. "Where are you in your monthly cycle?"