What laboratory tests should the nurse review for a patient with a possible myocardial infarction (MI)?
a. Urinalysis and complete blood count
b. Alkaline phosphatase and prothrombin time
c. Troponin I and myoglobin
d. Bleeding time and total cholesterol
ANS: C
The most useful indicators of an MI are patient history, electrocardiogram (ECG), and serum cardiac troponin I or T, myoglobin, and creatine kinase-MB (CK-MB) levels.
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An older adult patient whose medical history includes angina is gardening outside his home when he experiences a sudden onset of chest pain. This patient would most likely administer a dose of nitroglycerin by what route?
A) Subcutaneous injection B) Oral sustained-release tablet C) Nebulized inhalation D) Transmucosal spray
A group of children on one hospital unit are all suffering separation anxiety. When determining the stages of separation anxiety, the nurse recognizes that the child in the "despair" phase is the child who:
1. Lies quietly in bed. 2. Does not cry if his parents return and leave again. 3. Appears to be happy and content with staff. 4. Screams and cries when his parents leave.
A nurse is caring for a client after a stroke. What actions may the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.)
a. Assess neurologic status with the Glasgow Coma Scale. b. Check and document oxygen saturation every 1 to 2 hours. c. Cluster client care to allow periods of uninterrupted rest. d. Elevate the head of the bed to 45 degrees to prevent aspiration. e. Position the client supine with the head in a neutral midline position.
The nurse is assessing a child suspected of having pinworms. Which is the most common symptom the nurse expects to assess?
a. Restlessness b. Distractibility c. Rectal discharge d. Intense perianal itching