Which assessment finding for a patient in the community requires priority intervention by the nurse? The patient:
a. receives Social Security disability income plus a small check from a trust fund.
b. lives in an apartment with two patients who attend day hospital programs.
c. has a sibling who is interested and active in care planning.
d. purchases and uses marijuana on a frequent basis.
ANS: D
Patients who regularly buy illegal substances often become medication noncompliant. Medication noncompliance, along with the disorganizing influence of illegal drugs on cellular brain function, promotes relapse. The remaining options do not suggest problems.
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A nurse is documenting the results of assessment of a patient with bronchiectasis. What would the nurse most likely include in documentation?
A) Sudden onset of pleuritic chest pain B) Wheezes on auscultation C) Increased anterior-posterior (A-P) diameter D) Clubbing of the fingers
You are caring for a patient with late-stage Alzheimer's disease. The patient's wife tells you that the patient has become very dependent and that she feels guilty if she takes any time for herself because the patient cries out for her
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An older client is diagnosed with polycythemia vera and has a hematocrit of 58%. Which interventions are most important for the nurse to implement? Select all that apply.
1. Evaluate for activity intolerance 2. Assess for hypervolemia 3. Administer hydroxyurea 4. Assess for hypertension 5. Arrange for phlebotomy
What is most important for the nurse to teach the client with allergic rhinitis and glaucoma?
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