The client with multiple sclerosis asks the nurse what the myelin sheath does. The nurse responds by explaining that the myelin sheath:
1. Controls action potentials.
2. Regulates temperature in the CNS.
3. Stimulates the release of chemicals.
4. Increases nerve impulse velocity.
4
Rationale: The myelin sheath speeds conduction of the nerve impulse, and is found in most peripheral nerves.
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Objective data designating that the nutrition goals are not being met include:
a. hyperglycemia, normovolemia, and increased protein level. b. overhydration, hypoglycemia, and weight gain. c. weight gain, inconsistent glucose, and normovolemia. d. weight loss, elevated glucose, and dehydration.
A client is exhibiting signs of increasing intracranial pressure (ICP). Which intravenous solution (IV) would the nurse anticipate hanging?
A) Dextrose 5% in water (D5W) B) Half-normal saline (0.45% NSS) C) One-third normal saline (0.33% NSS) D) Mannitol (Osmitrol)
Which triad of symptoms should alert the nurse to a potential problem in a client with a fractured femur?
A) Chest pain, shoulder pain, hemoptysis B) Tachycardia, dyspnea, pleuritic pain C) Hemoptysis, chest pain, dyspnea D) Dyspnea, shoulder pain, tachycardia
The nurse obtains a new, dry nebulizer when preparing to give an elderly asthmatic client a nebu-lizer treatment because the risk of infection is increased because:
1. The client's age increases the risk factor for potential infection 2. The client's immune system is compromised as a result of asthma 3. There is a potential presence of Pseudomonas organisms in the reservoir 4. There is a chance for microorganisms to enter the body via the respiratory system