When suctioning a tracheostomy, the nurse should:
a. wear clean gloves.
b. insert the catheter without suction.
c. suction for 1 minute before removing the catheter.
d. place the used catheter in a plastic shield for later use.
B
Insertion of the suction catheter without suction reduces the probability of tissue injury.
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The nurse is talking with the mother of a client who is diagnosed with a traumatic brain injury. The mother states that she has never seen the client lash out when frustrated or throw things across the room
Which instruction, made by the nurse, is most correct? A) "The client may be experiencing a change in affect due to the brain injury." B) "The client has demonstrated this behavior before and is now anticipated." C) "The client has underlying aggression problems, which manifest in behavior." D) "All traumatic brain injury clients act in this similar way."
Approach behaviors are those coping mechanisms that result in a family's movement toward adjustment and resolution of the crisis of having a child with a chronic illness or disability. Which is considered an approach behavior?
a. Is unable to adjust to a progression of the disease or condition b. Anticipates future problems and seeks guidance and answers c. Looks for new cures without a perspective toward possible benefit d. Fails to recognize seriousness of child's condition despite physical evidence
The nurse anticipates that the 80-year-old African-American woman believes that her health will be improved by:
a. eating fresh fruits and vegetables. b. daily Bible reading. c. a visit from her pastor to pray for her recovery. d. the close attendance of her family.
The patient is prescribed an ophthalmic medication via an intraocular disc. Which action by the nurse is appropriate when administering the medication?
a. Place the disc in the conjunctival sac. b. Apply sterile gloves before placing the disc. c. Pull on the patient's upper eyelid and ask the patient to look up. d. Instruct the patient that the disc will be changed daily.