Solutions
a 12 year old child Is admitted to the hospital for observation
after sustaining a head injury. Twelve hours after the injury the
child has non of the signs and symptoms of a head injury. What
is the nurses priority intervention at this time? Correct Answers
assessing the level of consciousness every hour
A 5-year-old child undergoes cardiac catheterization. The child
is in the post-cardiac catheterization unit for 2 hours when the
incoming nurse receives the report from the outgoing nurse.
Which part of the child's report should the incoming nurse
question? Correct Answers bedrest with bathroom privileges
a child exhibits physical symptoms in response to stress. What
nursing intervention may help the client reduce the use of
physical symptoms as a response to stress? Correct Answers
assisting the client in developing new coping mechanisms
a client with a history of severe intermittent claudication has a
femoral-popliteal bypass graft. What is an appropriate
postoperative nursing intervention on the day after surgery?
Correct Answers assist the client with walking
a clients respiratory status deteriorates, and endotracheal
intubation and positive pressure ventilation are instituted. What
is the nurses most immediate intervention at this time? Correct
Answers assess the clients response to the interventions
, a nurse administers sodium polystyrene sulfonate (kayexalate) to
a client with chronic renal failure. Which findings provides
evidence that the intervention is effective? Correct Answers
potassium decreases to 4.2 mEq/L
A nurse has just received the assignment for the day shift. After
making initial rounds and checking all the assigned clients,
which client should the nurse plan to care for first? Correct
Answers a client with a fever who is diaphoretic and restless
A nurse in charge in the surgical intensive care unit notes that a
number of clients do not seem to be responding to morphine that
was administered for pain. Later in the evening the nurse finds a
staff nurse dozing in the nurses' lounge. When awakened, the
staff nurse appears uncoordinated and drugged, with slurred
speech. What should the nurse in charge do? Correct Answers
ask the nurse manager to be present before confronting the staff
nurse
a nurse is caring for several postoperative clients who had
abdominal surgery. What independent nursing intervention can
help prevent the development of thrombophlebitis? Correct
Answers helping the client perform in-bed exercises
a question about a power of attorney.. Correct Answers
a question that has "clustering, to allow time for breaks" as an
option. DONT REMEMBER THE ANSWER Correct Answers
BETA blocker and Lasix, with elderly Correct Answers risk for
dehydration