The nurse is conducting a nursing assessment of the parent and child with severe cerebral palsy during a routine clinic visit. Which nursing action is appropriate based on the current data?
1. Measuring the urine output
2. Measuring the child's head circumference
3. Observing the parent–child relationship
4. Observing how the child interacts during play
3
Explanation:
1. Measuring urine output is not important unless there are problems with the bladder.
2. Measuring the child's head circumference is not an important assessment at this time.
3. Observing the parent–child relationship is important to the success of health supervision for both the child and parents.
4. Playtime is not important during this time.
You might also like to view...
A patient is wearing an abdominal binder after abdominal surgery. What does the nurse need to assess and document about the patient?
a. Neurological response b. Respiratory status c. Lymphatic status d. Genitourinary response
Swanson's theory of caring is best demonstrated when the nurse:
1. Demonstrates efficiency when performing ordered treatments 2. Offers to stay with the client during a painful bedside procedure 3. Administers the client's pain medication promptly when requested 4. Frequently updates a family regarding a client's status during surgery
A patient is given a new medication and reports nausea within an hour after taking the drug. The nurse consults the drug information manual and learns that nausea is not an expected adverse effect of this drug
When the next dose is due, what will the nurse do? a. Administer the drug and tell the patient to report further nausea. b. Hold the drug and notify the provider of the patient's symptoms. c. Report the symptoms of nausea to the MEDWATCH program. d. Request an order for an antiemetic to counter this drug's effects.
The nurse is aware that a patient's values reflect influences from ____________________________. (Select all that apply.)
a. religion. b. philosophy. c. family. d. culture. e. society.