The nurse who is providing care for an older adult patient who has dementia has read in the patient's chart that she has developed skin breakdown in her perineum as a result of urinary and fecal incontinence. The nurse knows to specifically assess:
A) The skin in and around the woman's gluteal crease
B) The woman's labia majora and labia minora
C) The woman's urethral meatus and the adjacent mucus membranes
D) The area between the woman's vagina and rectum
D
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Prior to beginning a blood transfusion, it is essential for the nurse to:
1. check the client's intake and output. 2. question the client about any allergies. 3. measure the client's vital signs, including temperature. 4. determine if the client has had any previous transfusions.
The mother of an adolescent says that the child used to do
great in school but since using drugs the child has no motivation, is never on time, and makes the worst decisions, especially when he is driving. Which substance is this adolescent most likely abusing? A) Amphetamines B) Anabolic steroids C) Cocaine D) Marijuana
A client on the medical/surgical unit complains of sudden chest pains. Which is the first action the nurse will implement?
A. Call the health care provider. B. Administer pain medication. C. Reassess a new set of vital signs. D. Turn client from supine to lateral.
The primary healthcare provider prescribes a thyroid replacement drug to a patient with hypothyroidism. How should the nurse monitor for return to a euthyroid state?
A. Assess for anxiety and palpitations. B. Verify the medication history of patient and family. C. Evaluate the patient's knowledge of thyroid therapy. D. Analyze the patient's serum thyroid-stimulating hormone levels.