A parent comes to the health clinic with her child. The mother states, "Emily doesn't want to be held. She starts rocking and banging her head when strangers come in the room"
The nurse would suspect which of the following developmental disorders?
A) Mental retardation
B) Psychosis
C) Autistic disorder
D) Dyslexia
C
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The nurse is assigned care for a group of clients, and is deciding which client to see first. After report from the off-going shift, the nurse reviews the notes on each client. One client needs to be ambulated, and is one-day postoperative
Another client is three days postoperative, and is requesting pain medication. The third client is being discharged this afternoon, and the fourth client received a respiratory treatment for shortness of breath an hour ago. The nurse plans to assess the client who received the respiratory treatment first. Which element(s) of thought is the nurse using to prioritize her actions? Select all that apply. Standard Text: Select all that apply. 1. Interpretation and Inference 2. Assumptions 3. Concepts 4. Information 5. Implications and consequences
The nurse is preparing to measure the client's abdominal girth as part of the physical examination. At which location would the nurse most likely measure?
A) In the right upper quadrant B) At the umbilicus C) At the lower border of the liver D) Just below the last rib
The nurse prepares to administer pain medication to a client. Rank the following nursing interventions in order beginning with the initial action of the nurse to administer pain medication safely
1. Compare routes on an equianalgesic chart. 2. Determine the client response to analgesia. 3. Ask the client to rate the pain on 1–10 scale. 4. Check the last analgesia administration time.
The nurse recognizes that a client's hearing deficits impact the development of the nurse-client relationship. Which of the following has the greatest impact on minimizing this obstacle?
1. Speaking slowly, clearly, and in a normal tone 2. Using various forms of nonverbal communication 3. Relying heavily on touch to convey caring and interest 4. Involving family in discussions concerning meeting client's needs