Which assessment finding should the nurse be most concerned about for a client receiving pseudoephedrine (Sudafed)?
A. Temperature of 100°F
B. Respiratory rate of 22
C. Heart rate 82 and irregular
D. Complaints of a dry mouth
Answer: C
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You are the nurse working triage in the emergency department. A school-age child is brought in for treatment, carried by her mother. What is part of a primary assessment that should be performed first on this child?
a. Determine level of consciousness. b. Obtain a health history. c. Obtain a full set of vital signs. d. Evaluate for pain.
The nurse is conducting a staff in-service on multifetal pregnancy. Which statement about dizygotic twin development should the nurse include in the teaching session?
a. Dizygotic twins arise from two fertilized ova and are the same sex. b. Dizygotic twins arise from a single fertilized ovum and are always of the same sex. c. Dizygotic twins arise from two fertilized ova and may be the same sex or different sexes. d. Dizygotic twins arise from a single fertilized ovum and may be the same sex or different sexes.
The nurse is preparing to conduct a newborn assessment. Which equipment is appropriate for the nurse to use? Select all that apply
1) Stethoscope 2) Speculum 3) Tape measure 4) Thermometer 5) Penlight
A LPN who has been assigned four clients asks the charge nurse which client should be assessed first after report. Which client should the charge nurse suggest be assessed first?
a. A 56-year-old man with type I diabetes with 4 p.m. blood sugar of 92 b. A 77-year-old man with congestive heart failure (CHF) who has a potassium level of 3.1 c. A 24-year-old woman with pyelonephritis and a fever of 101.1°F d. A 38-year-old man with 22% deep par-tial-thickness burns of the legs and abdo-men.