Which of the following nursing actions is appropriate in the care of a patient with an implanted vascular access device?
A) Cleanse around the site of insertion with an antibacterial solution
B) Clean the external portion of the catheter after infusion is complete
C) Maintain patency by routine flushing with a heparinized solution
D) Observe the site only; only the physician will assess the site
Ans: C
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A patient admitted for delirium demonstrates increased disorientation and agitation only during the evening and nighttime. The nurse documents this as:
a. evening. b. nighttime. c. bedtime. d. sundowning.
A nurse teaches a student nurse about what type of occurrence requires completion of an incident report. The nurse recognizes that additional instruction is warranted when the student nurse states:
1. "If my patient falls out of a chair, I will complete an incident report." 2. "If I give the wrong medication to my patient, I will complete an incident report." 3. "If a visitor is injured while seeing my patient, I will complete an incident report." 4. "If my patient refuses to cooperate with physical therapy, I will complete an incident report."
The nurse is explaining cardiac reserve to a patient recovering from a myocardial infarction. Which example should the nurse use to explain this term?
1. getting on a treadmill and gradually increasing the pace of walking 2. breathing in through the nose and out the mouth while sitting quietly 3. sitting in a chair to cool down after completing an exercise routine 4. at the end of systole, approximately 50 mL of blood remaining in the ventricles
Which age group tends to think that death could not happen to them?
a. preschool c. preadolescent b. school-age d. adolescent