After administering promethazine (Phenergan) for nausea, the nurse takes extra precaution-ary implementations because of the common side effect of antiemetics, which is:
1. check vital signs for erratic blood pressure.
2. add a blanket to prevent chilling.
3. provide extra water to combat thirst.
4. put side rails up to prevent falls.
4
Most antiemetics cause drowsiness because of effects on the central nervous system, result-ing in dizziness and confusion.
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The nurse is admitting a 35-year-old patient to the preoperative unit in preparation for an elective inguinal hernia repair procedure to be performed under general anesthesia. What is the nurse's initial priority nursing assessment?
A) Assess the patient's anxiety. B) Start an IV. C) Show the family the waiting area. D) Weigh the patient.
A community health nurse is providing a class to new mothers on prevention of ear infections in their infants
The nurse asks the group, "How can you reduce the risk of acquiring acute otitis media (AOM), or middle ear infections, in your infants?" Which statement by one of the mothers most demonstrates a need for further teaching? a. "I shouldn't take my baby to a child care center if respiratory infections are pre-valent." b. "I should make sure my baby is not exposed to tobacco smoke." c. "I should not feed my baby her bottle when she is in a supine position." d. "I should administer acetic ear drops prophylactically."
On admission, a physician diagnoses a patient with rheumatoid arthritis. The nurse uses assessments to make the nursing diagnosis of Chronic Pain. What is the nurse diagnosing?
A) the pathology of the illness B) the response of the patient to the illness C) information from a nursing textbook D) knowledge from more experienced nurses
The nurse is preparing to assess a client's cranial nerves. Which of the following techniques should you use to assess cranial nerve III?
A) Shine a bright light in the client's eye and observe for bilateral pupillary response. B) Ask the client to close the eyes, occlude a nostril, then identify the smell of different substances. C) Determine visual acuity using a Snellen chart D) Occlude the patient's right ear, whisper a word into the left ear, and ask the patient to repeat it.