2 hrs post-op following an ileal conduit procedure bladder cancer ANS: Dusky-colored stoma
Administering an INJ to a client even after the client
... [Show More] states, "I don't want that injection. The last time I got that I was sore for a week." ANS: Battery
Admitting a client to the medical-surgical unit. Which of the following actions should the nurse first take? ANS: Observe the client's level of mobility
Adolescent client who has no previous history of a seizure disorder and is admitted after having a 3-min tonic-clonic seizure 2 wks after sustaining a mild concussion. EEG ANS: Explain that the client may not have coffee prior to the EEG
Adolescent who has cystic fibrosis and has a prescription for pancrelipase ANS: Take w/ meals
After evaluating the morning lab results on several clients, the provider writes prescriptions for 4 clients assigned to the nurses care? ANS: Infuse 10 meQ/l potassium chloride IV over 1 hr to a client who has potassium of 3.2
After making morning round, the charge nurse on a surgical unit delegates the follow tasks to the AP. ANS: Set up a room for an expected postoperative admission
AP reports to the nurse that another ap has spent the entire morning on the phone and has not completed the morning assignment ANS: Redirect the AP to discuss the issue with the other AP
Assessing client who systemic lupus erythematous SLE which of the following is an expected findings ANS: Dry, raised facial rash
At the start of an evening shift on a cardiac unit, a LPN brings the nurse a list of client reports ANS: Indigestion
Benefit from a three-way indwelling catheter ANS: Prone to development of blood clots un the urine
Caring for a client who has a new prescription for chlorpromazine by IM injection ANS: Check orthostatic BP 1 hr after admin
Caring for a client who was involved in a motor-vehicle crash. The client reports shortness of breath and chest pain and asks the nurse "Am I dying?" ANS: Admin pain meds
Charge nurse creating assignments for next shift for several nurses and one of the nurses is pregnant - which pt the nurse should NOT be assigned to? ANS: 60 yr old who is recovering from shingles
Charge nurse on pediatric unit is making assignments for a float nurse from the medical unit. Pt to see first? ANS: 10 yr old who has pneumonia & is receiving respiratory txs
Child who has pediculosis capitis ANS: store non-washable items in plastic bags for 14 days
Child who is unresponsive has ICP ANS: Pad the side of the bed
A client ask the nurse if it is safe for him to take glucosamine supplement? ANS: Shellfish allergy
Client following an open colectomy ANS: Uncontrolled pain
A client has just returned to the nursing unit following cardiac catheterization. In the immediate postoperative post procedure period which of the following is the priority nursing actions? ANS: Immobilizing the affect extremity
A client hopitialized for a bone marrow transplant is in protective isolation while undergoing total body radiation and intense chemotherapy. The clients sibling comes to visit but has obvious manifestations of an upper respiratory infection. ANS: Allow the sibling to visit after donning a sterile gown, mask, gloves but prohibits physical contact
Client recovering from closed head injury assumes a decerbrate posture in response to stimuli ANS: D lying flat ?? (Extentend extremities) The client rigidly extends his arm
Client reports chest pain. Which of the following lab findings indicates myocardial damage ANS: Troponin 1.8
Client who has a left femur fracture and is skeletal traction. The clients reports pain due to muscle spasms in affected leg ANS: Realign the extremity in traction
Client who has given birth to a stillborn ANS: Acknowledging the reality of the newborn's death
Client who is 2 days postoperative following a lumbar laminectomy and is reporting nausea ANS: Admin an antiemetic (Aprepitant for nausea)
Client who is 8hr postoperative following a right-modified radical mastectomy - which findings to report to provider? (SATA) ANS: Coughing [Show Less]