A nurse is preparing to administer a soapsuds enema to an adult client. Which of the following actions should the nurse take? - ANSWER Assist the client
... [Show More] to the left sims position
This position makes it easier for the enema solution to flow by gravity into the sigmoid and rectum and promotes retention of the solution. The nurse should also have the client's right leg flexed to facilitate tube insertion.
A nurse is caring for a client who had severe traumatic brain injury 3 weeks ago, remain unconscious, and is unlikely to recover. While bathing the client, the AP talks to him about current events. The client's partner asks the nurse why the AP talks to the client. Which of the following responses should the nurse make? - ANSWER "Although your partner is not responding to us, he might still be able to hear."
A nurse is assisting with discharge planning. Which of the following statements indicates that the nurse understands when to begin offering her input into the client's discharge plan? - ANSWER "I will begin upon the clients admission to the facility."
A nurse is preparing to document a clients information in the electronic medical record. Which of the following nursing statements identifies the purpose of documentation? - ANSWER "Documentation provides a communication tool for the health care team."
A nurse is caring for a client who has pneumonia. The client's oxygen saturation is 85%. Which of the following actions should the nurse take first? - ANSWER Raise the head of the bed
A nurse is caring for an older adult client who is at risk for skin breakdown. which of the following interventions should the nurse use to help maintain the client's skin integrity? - ANSWER Provide the client with a diet high in protein.
Inadequate protein, iron, vitamins, and calories increase the risk for skin breakdown.
An AP asks a nurse what precautions he should take when measuring the the vital signs of a client who has pneumonia. Which of the following responses should the nurse make? - ANSWER "Wear a mask when entering the client's room"
A nurse enters a client's room and finds the client pulseless. The nurse knows the client's family has requested do-not-resuscitate (DNR) status from the provider, but the provider has not written the prescription yet. Which of the following actions should the nurse take? - ANSWER Call the emergency response team [Show Less]