A client who is dependent on alcohol and drinks several six-packs of beer daily tells the nurse "Alcohol is no problem to me. I can quit anytime I want to." The nurse can assess this statement as indicating
A. denial.
B. projection.
C. rationalization.
D. reaction formation.
Ans: A. denial.
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For which client should the oxytocin (Pitocin) infusion be discontinued immediately?
a. Joan, in active labor with contractions every 3 minutes lasting 60 seconds each b. Mary, in transition with contractions every 2 minutes lasting 90 seconds each c. Nancy, in active labor with contractions every 2 to 3 minutes lasting 70 to 80 seconds each d. Amy, in early labor with contractions every 5 minutes lasting 40 seconds each
Which diagnostic laboratory test should the nurse anticipate being ordered for the purpose of evaluating an individual's acute, unexplained weight loss? Select all that ap-ply
a. A complete blood count (CBC) b. Urinalysis c. Fecal Occult Blood d. Serum Potassium e. Serum Electrolytes
The nurse is providing care to a Muslim patient who is near death. Which question by the nurse is appropriate in this situation?
1) "Will you want an autopsy performed after death?" 2) "Will you want to wash your loved one's body once death occurs?" 3) "Will you want Santero at the bedside for a prayer?" 4) "Will you want candles lit in the room after your loved one passes?"
A 58-year-old patient who has undergone a radical vulvectomy for vulvar carcinoma returns to the medical-surgical unit after the surgery. The priority nursing diagnosis for the patient at this time is
a. risk for infection related to contact of the wound with urine and stool. b. self-care deficit: bathing/hygiene related to pain and difficulty moving. c. imbalanced nutrition: less than body requirements related to low-residue diet. d. risk for ineffective sexual pattern related to disfiguration caused by the surgery.