The nurse determines that a 60-year-old client requires further teaching regarding measures to prevent pulmonary infection if the client makes which of the following statements?
1. "Even though I have diabetes, I won't need to obtain the pneumococcal vaccine until I'm 65 years old.".
2. "I will make sure I carefully wash my hands after blowing my nose, after using the restroom, and before eating.".
3. "Since I have diabetes, I will make sure I get the influenza vaccine each year.".
4. "I will be participating in a smoking cessation support group after discharge.".
"Even though I have diabetes, I won't need to obtain the pneumococcal vaccine until I'm 65 years old.".
Rationale: Clients with chronic conditions such as diabetes are candidates for both the influenza and pneumococcal vaccines regardless of age. Even though the client is 60 years old, the client should receive the vaccine because it is 60% effective in preventing bacterial pneumococcal infections in adults. Meticulous hand hygiene and smoking cessation are integral in prevention of pulmonary infection.
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You teach a child with type 1 diabetes mellitus to administer her own insulin. She is receiving a combination of short-acting and long-acting insulin. You know that she has appropriately learned the technique when she
A) administers the insulin into a doll at a 30-degree angle. B) draws up the short-acting insulin into the syringe first. C) wipes off the needle with an alcohol swab. D) administers the insulin intramuscularly into rotating sites.
A nursing instructor is teaching about the application of Peplau's theory to nursing care. Which student statement indicates that learning has occurred?
A. "The nurse assumes the role of a parenting figure, instructing the client in good health practices." B. "The nurse is concerned more about psychosocial functioning than physiological functioning." C. "The nurse bases the client care plan on standardized nursing approaches and physician orders." D. "The nurse applies principles of human relations to the problems that arise at all levels of experience."
Vital signs are immediately reported to the nurse at which of the following times?
a. Whenever they are taken b. If there is a change from a previous mea-surement c. Every time you take them d. Every other time you take them
A patient tried to gouge out his eye in response to auditory hallucinations commanding, "If thine eye offends thee, pluck it out." The nurse would analyze this behavior as indi-cating:
a. Derealization b. Inappropriate affect c. Impaired impulse control d. Inability to manage anger