An older patient with end-stage renal and heart failure is experiencing odd dreams and is talking with people who are not present in the room. What does this finding indicate to the nurse?
1. Pending death
2. Ineffective pain medication
3. Overdose of narcotic medication
4. Normal visual and auditory hallucinations at the end of life
4
Rationale: Respiratory, neurological, and cardiac changes are more likely to indicate impending death.
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A nurse assesses a client with a neurologic disorder. Which assessment finding should the nurse identify as a late manifestation of amyotrophic lateral sclerosis (ALS)?
a. Dysarthria b. Dysphagia c. Muscle weakness d. Impairment of respiratory muscles
Which of these statements about the application of moist heat is TRUE?
a. It is the preferred treatment for open wounds. b. It provides more immediate relief from pain or spasm than dry heat. c. It increases overall body temperature. d. It is effective only when adequate vasculature is present.
A patient diagnosed with gouty arthritis is prescribed the drug colchicine to reduce symptoms. Which medication education should the nurse provide?
1. There is a possibility of orthostatic hypotension. 2. A diet with fewer restrictions on purine ingestion may be adopted. 3. The pain will diminish, but the joint will remain swollen and red. 4. Vomiting and/or diarrhea are common side effects of this medication.
The primary care provider orders a calorie count for a patient who is malnourished. Over a 24-hour period, the patient consumes 24 grams of fat. Which of the following denotes the patient's caloric intake of fat?
1. 96 2. 120 3. 216 4. 240