A nurse suspects a patient has a chest wall injury and wants to collect more data about thoracic expansion. Which is the appropriate technique to use?
a. Place the palmar side of each hand against the lateral thorax at the level of the waist, ask the patient to take a deep breath, and observe lateral movement of the hands.
b. Place both thumbs on either side of the patient's T9 to T10 spinal processes, extend fingers laterally, ask the patient to take a deep breath, and observe lateral movement of the thumbs.
c. Place both thumbs on either side of the patient's T7 to T8 spinal processes, extend fingers laterally, ask the patient to exhale deeply, and observe lateral inward movement of the thumbs.
d. Place the palmar side of each hand on the shoulders of the patient, ask the patient to sit up straight and take a deep breath, and observe symmetric movement of the shoulders.
ANS: B
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A physician prescribes oral aripiprazole 10 mg daily for a client with schizophrenia. This medication is unfamiliar to the nurse, and she cannot find it in the hospital formulary or other references. How should she proceed?
1) Administer the medication as ordered. 2) Hold the medication and notify the physician. 3) Consult with a pharmacist before administering it. 4) Ask the patient's RN for information about the medication.
The parents of a 13-month-old infant requiring a veinipuncture for laboratory studies ask the nurse what they can do to help with pain during the procedure. Which of the following would be the best action for the nurse to take?
1. Have the parents leave the area during the procedure. 2. Tell the parents to touch and reassure the infant during the procedure. 3. Wait until the infant is asleep to do the procedure. 4. Administer an analgesic 30 minutes before the procedure.
The doctor orders testing for glucosuria and ketones. When are these tests usually done?
a. During AM and HS care b. After meals c. 30 minutes before each meal and at bed-time d. Every time the person urinates
How might case management be defined?
A. An incident needing intervention B. Another term for cost containment C. Development and coordination of a plan of care for a client D. Managing groups of cases of patients having a specific illness