While auscultating the heart of a 5-year-old child, the nurse notes a murmur that is soft and quiet and heard each time the heart is auscultated. The nurse documents this finding as which of the following?
A) Grade 1
B) Grade 2
C) Grade 3
D) Grade 4
B
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An infant is born at 35 weeks and 3 days. How would the nurse document this gestational age? ____________________
ANS:
A child with a head injury sleeps unless aroused, and when aroused responds briefly before falling back to sleep. What should the nurse chart for this child's level of consciousness?
a. Disoriented b. Obtunded c. Lethargic d. Stuporous
A toddler weighing 22 lb with hemophilia A fell down several steps and sustained a knee injury. The parents have been instructed to provide the child with an infusion of factor VIII concentrate, one bag per 5 kg of body weight
How many bags of the concentrate will the parents infuse into the child? (Calculate to the nearest tenth decimal point.)
Which of the following are appropriate actions by the nurse during the immediate postmortem period? (Select all that apply.)
a. Remove all tubes, medical supplies, and equipment from the bedside. b. Provide the family a place away from the patient's room to talk and grieve. c. Bathe and dress the patient. d. Ask the family if they want the patient's face covered or uncovered. e. Recommend that the family donate the patient's organs as a way to find meaning from the death. f. Notify the physician with the patient's time of death per institutional policy.