A nurse is updating the plan of care for a client who is 48 hr postoperative quizlet. Implement bleeding precautions.
A nurse is updating the plan of care for a client who is 48 hr postoperative quizlet. implement bleeding precautions 2.
A nurse is updating the plan of care for a client who is 48 hr postoperative quizlet A nurse in a pediatric Which of the following actions should the nurse take?, 2. A nurse is updating the plan of care for a client who is 48 hr postoperative following a laryngectomy and is unable to speak. Which of the following findings should the nurse report to the provider? A. Ask Question. A nurse is reviewing the medical record of a client A nurse is updating a plan of care for a client who is receiving intermittent enteral feedings and is experiencing diarrhea. Feed Study with Quizlet and memorize flashcards containing terms like A nurse is caring for several newborns. Which collaborative action should the nurse include? (Select all that apply. Study with Quizlet and memorize flashcards containing terms like •Assess for the presence of a swallow reflex Place the food on the affected side of the mouth •Assist the client with eating •Thicken liquids •Provide ample time for the client to chew and swallow, Red skin areas under the jacket, Decorticate rigidity and more. Which of the following interventions should the nurse include in the plan? A. Allow the client at least 1 hr for each meal. Which of the following interventions should the nurse include in the plan? Discard the client's opened cans of formula within 48 hr. After reviewing the client's medical record, which of the following provider prescriptions should the nurse plan to implement?The nurse should plan to implement the provider's prescription for a Select and Select Study with Quizlet and memorize flashcards containing terms like A nurse is caring for several newborn clients. ) a. This intervention is crucial in preventing aspiration or choking because it helps to ensure that food or liquids are efficiently guided into the esophagus and not the trachea. Instruct the client that the drain will be removed when there is 25 mL of output or less over a 24-hr period. Study with Quizlet and memorize flashcards containing terms like A nurse is discussing the precautionary measures that need to be taken to prevent further complications with a patient who has hepatitis. While not returning with the medication may have resulted in the client experiencing continued discomfort, fidelity is more directly applicable in this scenario. Which of the following tasks should the nurse assign to an assistive personnel (AP)? A. Which of the following actions should the nurse take, A nurse is evaluating the safe use of electrical equipment by a newly hired assistive personnel (AP). Sign up. The client tells the nurse that they are leaving the hospital. Study with Quizlet and memorize flashcards containing terms like There has been a community disaster and stable clients must be discharged from a facility to prepare for the influx of new casualties. C. Which of the following interventions should the nurse implement to increase the client's nutritional intake? 1. Get a hint. Study with Quizlet and memorize flashcards containing terms like A nurse is performing an admission assessment on a client who has major depressive disorder (MDD). FLAG A nurse is updating the plan of care for a client who is 48 hr postoperative following a laryngectomy and is unable to speak. Which is an appropriate nursing action to prevent pulmonary complications? 1 Ambulating the client to increase respiratory exchange 2 Promoting frequent turning and deep breathing to mobilize secretions 3 Maintaining a consistent oxygen flow rate Study with Quizlet and memorize flashcards containing terms like During the emergent phase of burn care, the client is at risk for developing_____ and _____, A nurse is reviewing the medical record of a client who is postoperative. The client received an opioid analgesic 1 hr prior. Which actions should the nurse plan to take first, A nurse is teaching a pt who has a new RX for TPN through a central line. Calcium A nurse is contributing to the plan of care for a client who was admitted to the neurological unit following a stroke 3 hr ago. Which of the following guidelines should the nurse include? A. Comprehending these necessities is crucial for delivering care that honors and upholds the patient's convictions, so considerably augmenting their general welfare. wh Skip to main content. Which of the following actions should the nurse plan to take first? a. Which criterion differentiates this plan of care from other types? Select all that A nurse is caring for a client who is 48 hours postoperative following a total hip arthroplasty. Changing the medication order after speaking with the client about adverse effects B. yellowing of the skin d. Weigh the client at bedtime each day. hello quizlet. When the nurse attempts to administer oral lorazepam, the client refuses to take the medication and becomes physically aggressive. Although each care plan is individualized, there are certain risks and health problems that clients undergoing similar Study with Quizlet and memorize flashcards containing terms like A nurse is assessing a client who is 4 hr postoperative following a total laryngectomy. They focus on the patient's perception of needs. Assist the client to start arm exercises 48 hr Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client The nurse is evaluating the client's plan of care. "You can refuse the medication. Maintain the client Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client who has impaired cognition. For students. Select one option in each row. Client is resting and easily awakened. Instruct the client on the technique for esophageal speech. boardlike abdomen, A nurse is teaching a client who has diabetes mellitus about hypoglycemia. Study with Quizlet and memorize flashcards containing terms like A nurse is reviewing the plan of care for a client. On review of the clients' medical records, the Study with Quizlet and memorize flashcards containing terms like comprehensive plan of care is, comprehensive plan of care includes (4), client profile includes and more. Use a mummy restraint to hold the child during the catheter insertion. Which assessment finding would the nurse note in a client with this condition?, The nurse is assigned to care for a group of clients. Limit coffee C. Although the client does not want to leave the unit, the nurse requests the provider to transfer the client to a unit that is equipped to manage violent behavior. The nurse recognizes that the client's surgery will have a significant impact on the client's activities of daily living (ADLs) during the period of recovery. ) A. clarkeswain123. Each finding may Study with Quizlet and memorize flashcards containing terms like A nurse is performing a cognitive assessment to distinguish delirium from dementia in a client whose family reports episodes of confusion. I can't imagine giving it up. (Unable to read) B. A plan derived from a consensus of opinions of all staff members c. A nurse is updating the client's plan of care. This is an appropriate outcome because it indicates that the wound is healing properly and that the client is receiving adequate wound care and infection prevention measures. Areas of warmth on the A nurse is planning care for a client who is having modified radical mastectomy of the right breast. Assist the client with active range-of-motion exercises. Which of the following actions should the nurse take?, A nurse is reinforcing teaching with a client who has A nurse is updating the plan of care for a client who has bulimia nervosa and is 5% above his ideal body weight. Study with Quizlet and memorize flashcards containing terms like A nurse is assessing for compartment syndrome in a client who has a short leg cast. Aspiration B. How will this affect the nursing care plan? 1. The provider instructed the Study with Quizlet and memorize flashcards containing terms like The nurse is assisting in evaluating and updating a client's plan of care. Hypernatremia B. Hypotension C. Feed A nurse is updating the plan of care for a client who has bulimia nervosa and is 5% above his ideal body weight. Study with Quizlet and memorize flashcards containing terms like What is an example of a nurse-initiated intervention?, Nurses on an orthopedic nursing unit use standardized care plans that incorporate nursing, physical therapy, occupational therapy, and case management actions for clients who experience a particular surgery. "This Study with Quizlet and memorize flashcards containing terms like The nurse caring for a client who has been receiving intravenous (IV) diuretics suspects that the client is experiencing a fluid volume deficit. Show the client A nurse is reviewing the plan of care for a client who has cellulitis of the leg. Which of the following interventions should the nurse include in the plan of care?. A nurse is providing discharge teaching for a client who has an implantable cardioverter defibrillator which of the following A nurse is caring for a client who has impaired cognition. Anticipate nutritional problems caused by nausea Study with Quizlet and memorize flashcards containing terms like A nurse is planning care for an adult client with significant cognitive impairments and a new diagnosis of cancer. Desire for sexual The nurse is updating the plan of care for a client who is 48 hours postoperative following a laryngectomy and cannot speak. A nurse is caring for a client who is postoperative following a parathyroidectomy to treat hyperparathyroidism. Bring a pitcher of fresh Individuals with this disorder have a skewed perception of their bodies and a strong fear of gaining weight that leads them to participate in these harmful habits. Show the Study with Quizlet and memorize flashcards containing terms like A nurse is preparing to teach about dietary management to a client who has Crohn's disease and an enteroenteric fistula. Which of the following nursing goals is priority in Study with Quizlet and memorize flashcards containing terms like A nurse is assessing a client who is experiencing perforation of a peptic ulcer. Client reports their sputum is Study with Quizlet and memorize flashcards containing terms like A nurse in an emergency department is caring for a female adolescent who has a diagnosis of bulimia nervosa and has a fainting episode during a ballet performance. The nurse integrates knowledge of this condition, anticipating that the client's affect and behavior Study with Quizlet and memorize flashcards containing terms like A nurse assesses the vital signs of a client who is one day postoperative in which a colostomy was performed. , A nurse is caring for a 2-month-old infant who is postoperative following surgical repair of a cleft lip. Limiting Nursing; Nursing questions and answers; A nurse is updating a plan of care for a client who is receiving intermittent enteral feedings and is experiencing diarrhea. The nurse should check to see that which medication is available in the stock medication supply for possible use to reverse this elevation? a. What action Study with Quizlet and memorize flashcards containing terms like The nurse is planning care for a client following a surgical procedure. Which of the following is the priority criterion the RN should consider when delegating?, A nurse is a nurse is caring for a client who is 2 days postoperative following a cholecystectomy. Study with Quizlet and memorize flashcards containing terms like After a subtotal gastrectomy, a client is returned to the surgical unit. Which of the following actions should the nurse take to provide the client with unbiased care? (Select all that apply. A nurse is updating a plan of care for a client who is receiving intermittent enteral feedings & is experiencing diarrhea. Which of the following actions should the nurse take? -Encourage a nurse is updating a plan os care for a client who is receiving intermittent enteral feedings and is experiencing diarrhea. Brainly Tutor. Yellow-Green drainage on the surgical incision D. I will notify your provider. , A nurse is monitoring a client who began taking sertraline 3 days ago. Which of the following findings is the priority for the nurse to report to the provider?, A nurse is assessing a client who has acute respiratory distress syndrome (ARDS). Which of the following findings should the nurse report to the In caring for a client with deep-vein thrombosis (DVT), the nurse should ensure that the affected limb is elevated while sitting, promote movement of the affected limb, and administer medications and other interventions. I always have to get my blood checked. Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client who has a history of substance use disorder and was involuntarily admitted to a mental health facility. docx. Explanation: When a patient is recovering from a laryngectomy, it's important to provide comprehensive care to ensure health and safety. 1 / A nurse is preparing for a teaching session with a client. How many blood vessels should the nurse expect to observe in the newborn's umbilical cord?, A nurse is assisting in the care of a newborn shortly after birth. They are based on assessment and diagnosis. Which of the following findings should the nurse identify as a manifestation of this condition? A. Home. A. They require input from a Study with Quizlet and memorize flashcards containing terms like The nurse decides to use a standardized plan of care to address a client's health problems. determine clients reading skills b. 1 mmol/L). It is often used by medical professionals (e. Which of the following nutrients should the nurse instruct the client to decrease in their diet?, A nurse is updating the plan of care for a client who is 48 hr postoperative following a Study with Quizlet and memorize flashcards containing terms like A nurse is caring for four clients in an emergency department. Complete the following sentence by using the lists of options. When updating the client's provider on the client's current health status, what assessment finding should the nurse prioritize? a. Reinforce measures and teaching and regarding preventing infections 3. Sliced bananas B. " Which of the following responses should the nurse provide? A. Which of the following findings should the nurse expect the client to report? (Select all that apply. Correct Although each care plan is individualized, there are certain risks and health problems that clients undergoing similar medical or surgical treatment have in common. Updating the plan of care for a client who is postoperative B. The nurse should plan to monitor the client for which of the following adverse effects?, A nurse is caring for a client with ADHD who has recently started taking lithium. NURS. 3. Which of the following pieces of information should the nurse consider when planning care that is culturally congruent? Illness is not influenced by culture The meaning of disease can vary widely across cultures Assigning clients to specific cultural categories Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client who is postoperative following an above-the-knee amputation of the right leg and reports pain in the absent portion of the limb. Which of the following findings should the nurse identify as the priority? Report of sore throat which could be a manifestation of an infection. Informing the dietician that the client is on a special diet and needs reteaching about Study with Quizlet and memorize flashcards containing terms like A nurse caring for a client admitted with a deep vein thrombosis is individualizing a prepared plan of care that identifies nursing diagnoses, outcomes, and related nursing interventions common to this condition. Blood pressure 102/66 mm Hg B. Which of the following actions should the nurse include in the plan of care? A. Place client on a full liquid diet. Study with Quizlet and memorize flashcards containing terms like A nurse is planning care for a client who is 4 hr postoperative. What is the nurse's primary responsibility for the use of complementary Study with Quizlet and memorize flashcards containing terms like The nurse receives report on assigned clients. Generate. For which of the following findings should the nurse notify the charge nurse?, A nurse is caring for a newborn who has a myelomeningocele and is admitted to the newborn intensive care unit (NICU) to await surgery. Which of the following interventions should the nurse recommend? 1) Apply topical antifungal agents. Improve your grades and reach your goals with flashcards, practice tests and expert-written solutions today. Eat with metal utensils B. plans of care. Administer low dose heparin B. Which of the following food choices by the client indicates an understanding of the teaching? A. The client states, "I don't like to take this medication. Will she still be able to Find step-by-step Health solutions and the answer to the textbook question The nurse is updating the plan of care for a patient with a stage III pressure ulcer and a nursing diagnosis of Impaired skin integrity. What action by the nurse best communicates this change in basic care needs for the client?, Which Nursing; Nursing questions and answers; A nurse is updating a plan of care for a client who is receiving intermittent enteral feedings and is experiencing diarrhea. Log in Join. Find step-by-step Health solutions and the answer to the textbook question A nurse is developing a plan of care for an older client who is being admitted to a long-term care facility. Which of the following actions by the AP demonstrates an Study with Quizlet and memorize flashcards containing terms like A nurse in a pediatric unit is preparing to insert an IV catheter for 7-year-old. Anemia D. Which of the following interventions should the nurse identify as the priority? Encourage the client to participate in self-care. A nurse should identify that which of the following clients is safe to discharge?, A nurse on a medical-surgical unit is caring for four clients. Inability to concentrate on simple tasks C. Pain that increases with passive movement D. Ensuring adequate oxygenation is critical, as hypokalemia can lead to respiratory muscle weakness. which of the following findings should the nurse identify as a complication of surgery?, The client is experiencing manifestations of _____ due to the Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client who is postoperative and has a history Addison's disease. The client is at risk for developing _____ due to _____ Dropdown 1: -Extrapyramidal side effects -Hypertensive crisis Study with Quizlet and memorize flashcards containing terms like The nurse asks the nurse manager, "What do initial planning, ongoing planning, and discharge planning have in common?" Which information from the nurse manager is correct? 1. Which of the following interventions should the nurse identify as the priority?, A nurse is contributing to the plan of care for a client who has peripheral arterial disease of the lower extremities. Study with Quizlet and memorize flashcards containing terms like A nurse is preparing to perform an abdominal assessment on a client. increased blood pressure b. 5 mmol/L)?, The nurse is caring for a client with a nasogastric (NG) tube Study with Quizlet and memorize flashcards containing terms like A nurse manager is updating protocols for the use of belt restraints. 4) Keep draining lesions uncovered to Study with Quizlet and memorize flashcards containing terms like A nurse manager is updating protocols for the use of belt restraints. Which of the following dietary recommendations should the nurse relay? A. Study with Quizlet and memorize flashcards containing terms like A nurse identifies a clients health care needs and devises a plan of care to meet those needs. For which of the following findings should the nurse monitor Quizlet has study tools to help you learn anything. anticipate nutritional problems caused by Study with Quizlet and memorize flashcards containing terms like A client is experiencing anorexia related to cancer treatment. Create. Bounding pedal pulse B. "Let's discuss this with your doctor; giving up daily pasta may not be necessary. total plan of care for a patient. The nurse should identify that which of the following clients can give informed consent?, A nurse is teaching a newly licensed nurse about nursing care plans for clients who have depressive disorders. Tell the child they will feel discomfort during the catheter insertion. Given the context of postoperative care and considering the principles of airway management, the first action should be to assess the client's Study with Quizlet and memorize flashcards containing terms like A nurse is preparing to teach about dietary management to a client who has Crohn's disease and an enteroenteric fistula. 2. calcitonin b. Provide the client with an alphabet board. Infection C. 1 / 40 RN Comprehensive ATI missed questions. which of the following interventions should the nurse include in the plan? feed the client in small frequent volume WHY: The nurse should administer the feedings in small, frequent volumes because a large volume or rapid feeding of the formula can cause diarrhea. Which of the following assessment findings supports the nurse's suspicion of delirium?, A nurse is caring for a client who gave birth to a stillborn baby. Plain yogurt with peaches, A nurse is assisting with the plan Study with Quizlet and memorize flashcards containing terms like A nurse is preparing to administer a client's anticoagulant medication. comprehensive plan of care is. Recommend cooking aromatic foods to stimulate appetite 2. " B. A nurse is updating the plan of care for a client who has bulimia nervosa and is 5% above their ideal body weight. , Determine the priority of each of the nurse's actions. Ask whether patient's expectations are being met. Providing cooked fruits such as prunes or apricots\ B. When updating a teaching plan for a patient who has cancer and has been taking doxorubicin (Adriamycin) for the past several months, the nurse needs to emphasize the importance of monitoring for cardiotoxicity symptoms such as shortness of breath and irregular heartbeats and monitor for signs of infection due to the medication's potential to damage the heart and A nurse is updating the client's plan of care. Total views 100+ Georgia State University. A normal bowel patern is what's normal for each person, and it can vary depending on factors such as diet, age, physical activity, and health conditions. Exhibit 1: Day 1, 1715: Client is 6 hr postoperative following abdominal surgery. Which of the following action should the nurse include in the plan of care?, An RN is delegating care activities to licensed practical nurse (LPN). Study with Quizlet and memorize flashcards containing terms like A nurse is reinforcing discharge teaching with a client who is receiving intermittent enteral feedings through a gastrostomy tube. Include a liquid supplement with meals. The question asks which action the nurse should plan to take first. Potential Intervention: 1. Allow the client at least 1 hour for each meal. What type of tool is the nurse using?, A client was admitted 2 days ago with sepsis. Which of the following interventions should the nurse include in the plan? - Discard the client's opened cans of formula within 48 hr. Which of the following actions should the Study with Quizlet and memorize flashcards containing terms like A nurse is providing teaching to a client who has type 2 diabetes mellitus. Which priorities of care should the nurse include? Select all that apply, Which client is at risk for the development of a potassium level of 5. Which of the following statements by the parent acknowledges the client's diagnosis?, A nurse is caring for a child who has conduct disorder Study with Quizlet and memorize flashcards containing terms like A client is unconscious and unable to provide input into outcome identification. For which of the following manifestations should the nurse monitor? A. A plan designed to support the client physically b. Turkey and cheese sandwich D. Areas of warmth on the Study with Quizlet and memorize flashcards containing terms like A nurse is caring for several newborn clients. Flashcards; Learn; Test; Match; Q-Chat; Get a hint. which of the following interventions should the nurse include in the plan? There are 2 steps to solve this one. Which of the following statements by the newly Study with Quizlet and memorize flashcards containing terms like A nurse is updating the client's plan of care. Straw-colored urine from an indwelling urinary catheter C. Study tools. A draw sheet is a small bed sheet placed crosswise over the middle of the bottom sheet of a mattress to cover the area between the person's upper back and thighs. Administer low dose heparin. -Assess -Plan -Prescribe -Implement -Evaluate, The nurse is creating a plan of care for a client. Find step-by-step Health solutions and the answer to the textbook question The nurse is caring for a client who has just returned from an overseas trip and been diagnosed with malaria. Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client who is receiving radiation therapy for breast cancer and reports a metallic taste in the mouth. the client has been vomiting for the past 24 hr and reports a pain level of 8 on a 0 to 10. The nurse Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client in an outpatient psychiatric clinic who has been applying a selegiline 12 mg transdermal patch once daily. exhibit 1 Medical History Day 1, 0800: Client treated for UTI 8 months ago. For which of the following findings should the nurse notify the charge nurse?, A nurse is caring for a newborn. The nurse is preparing to assess a client with a paranoid personality trait. Which of the following client statements requires further teaching by the nurse?, A nurse is planning care for a client who has a peptic ulcer and a new prescription for sucralfate 2 gm Study with Quizlet and memorize flashcards containing terms like A client has been admitted to the hospital for the treatment of exacerbation of chronic obstructive pulmonary disease. Which guideline is being followed?, The nursing process includes step(S) Select all that apply. , The nurse is planning care for an older adult client who weighs 43 kilograms, is confused, and has bilateral leg contractures. Find step-by-step Health solutions and the answer to the textbook question A nurse is planning the care of a 48-year-old woman who has just received a diagnosis of breast cancer. Which of the following information should the nurse plan to include?, A nurse in a provider's office is caring for a client who has a new Study with Quizlet and memorize flashcards containing terms like The nurse is caring for a client with Paget's disease who has a serum calcium level of 12. Which statement made by the patient indicates a need for further discussion? A go to the bed at the same time every night B watch television in bed until you are asleep C drink a A bowel patern is the frequency, consistency, and appearance of a person's bowel movements. The nurse should identify which of the following findings as an Study with Quizlet and memorize flashcards containing terms like A nurse is assessing a client who is 48 hours post-op following abdominal surgery. Which intervention should the nurse include in the plan of care to help maintain an appropriate bowel elimination pattern? A. Which statement constitutes a long-term outcome for this client?, A client is required to have nothing by mouth (NPO) for 8 hours prior to a test scheduled for tomorrow. Which type of care plan do these nurses use?, A Study with Quizlet and memorize flashcards containing terms like A charge nurse is planning an educational session for staff nurses about working with parents whose children have a terminal illness and are candidates for donating their organs. which for the following interventions should the nurse include in the plan? Discard the clients opened cans of formula within 48 hr Administer the clients formula cold Feed the client small frequent volumes Consider low Study with Quizlet and memorize flashcards containing terms like What is the Nursing plan of care?, When is it Initiated?, How often is it update? and more. Specific to this topic, if a client suffers from bulimia nervosa and is 5% overweight, the nurse should concentrate on behavioral, nutritional, and psychological therapies that includes a balanced meal plan that can be Find step-by-step Health solutions and the answer to the textbook question A nurse is caring for a client who is 48 hours postoperative following a total hip arthroplasty. show the client how to use an artificial larynx In updating the client's plan of care based on the new onset of hypokalemia, the nurse should prioritize the following: ensure adequate oxygenation, provide assistance to prevent falls, and monitor for numbness and tingling around the mouth. The nurse should convey the client's pain status in which portion of the report?, A nurse is providing discharge teaching to a client who is recovering from lung cancer. 5 mEq/L (5. after conferring with the provider, which of the following actions should the nurse take first? A nurse is caring for a client who is 48 hours postoperative following a total hip arthroplasty. " A nurse is updating a plan of care for a client who is receiving intermittent enteral feedings and is experience diarrhea. Which of the following actions should the nurse plan to A nurse is updating the plan of care for a client who is 48 hr postoperative following a laryngectomy and is unable to speak. Use an incentive spirometer every 3 hours D. One client is reported to be at the nadir for his cancer chemotherapy. Which factor increases this client's risk for delirium? Select all that apply. Which of the following actions should the nurse plan to A nurse is updating the plan of care for a client who is receiving chemotherapy. Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client who is 12 hr postoperative following a total hip arthroplasty. The nurse repositions the client to her left side and updates the plan of care to turn and reposition the client every hour. Pages 16. For each of the following potential nursing interventions, click to specify if the potential intervention is anticipated, nonessential, or contraindicated for the client. Identify the client's trigger foods. Flashcards. Identify the sequence of steps the nurse should take to conduct the assessment. Compare the client to a Choice A reason: Blood pressure is not a priority finding for a newborn with neonatal abstinence syndrome (NAS). menu. A nurse is updating the client's plan of care. Which of the following manifestations should the nurse expect? a. Which of the following actions should the The nurse updates the client's care plan based upon improvements in his condition. Which of the following statements by the parent acknowledges the client's diagnosis? A. Which of the following laboratory values should the nurse expect to decrease as a therapeutic effect of the procedure? A. Which of the following interventions should the nurse include in the plan of care? A) Discard the client's opened cans of formula within 48 hours B) Administer the client's formula cold C) Study with Quizlet and memorize flashcards containing terms like 1. Serve hot foods rather than cold foods 3. a nurse is updating a plan of care for a client who is receiving intermittent enteral feedings and is experiencing diarrhea. close. - Administer the client's formula cold. Which of the following findings indi Nurses' Notes Day 1, 1530: Client presents to the emergency department with reports of a cough, sore throat, chills, fever, and shortness of breath which began 2 days ago. When the nurse spends an appropriate amount of time with each client regardless of their behavior and in keeping with their individual needs, the nurse guarantees that all clients receive equal care. When addressing the Find an answer to your question A nurse is updating the plan of care for a client who is 48 hr postoperative following a laryngectomy and is unable to speak. g. Capillary refill less than 2 seconds C. Which of the following actions should the nurse take?, A nurse is monitoring a client who is 12 hr post-op following a cholecystectomy and received morphine 30 mins ago for pain. 2) Apply fresh ice packs every 4 hr. Which of the following findings should the nurse identify as the priority?, A nurse is reviewing the medical record of a client who has a prescription for probenecid to treat gout. Alert and oriented to person, place, and time. decreased heart rate c. vitamin d c. Baked potato C. Difficulty sleeping for several weeks B. Since warfarin is an anticoagulant, the medication must be monitored to ensure the anticoagulation is within therapeutic range and prevent hemorrhage (high levels of anticoagulation) or stroke, MI, or PE (low levels of anticoagulation). A nurse is caring for a client who has acute diverticulitis and is scheduled for surgery within the next 2 hr. Which of the A nurse is updating the plan of care for a client who is receiving chemotherapy. Nonmaleficence: This ethical principle relates to the duty to do no harm to the client. When updating the plan of care of a client who has dysphagia, the nurse should include the intervention of having the client sit upright for 1 hour following meals. Reinforcing teaching with a client who is learning to walk using a quad A nurse is updating a plan of care for a client who is recieveing intermittent enteral feedings and is experiencing diarrhea. Show the Spending adequate time with a client who is verbally abusive By spending adequate time with a client who is verbally abusive, the nurse is demonstrating the ethical principle of justice. Elevation and movement of the affected limb will help re-establish blood flow in the vessels of the affected limb, thereby preventing worsening of the condition. Remove the client's restraint every 4hr B. What are these actions considered?, Ongoing planning, The nurse is considering the needs of the postoperative client in the home setting. D. Find step-by-step Health solutions and the answer to the textbook question A nurse is planning care for an older adult client who has dementia. Which of the following nutrients should the nurse instruct the client to decrease in their diet?, A nurse is updating the plan of care for a client who is 48 hr postoperative following a Study with Quizlet and memorize flashcards containing terms like For each of the provider's potential prescriptions, click to specify if the potential prescription is anticipated, nonessential, or contraindicated for the client. Require the parents to a nurse is updating the plan of care for a client who is 4 8 hr postoperstive following a laryngectomy and is inable to speak Here’s the best way to solve it. and more. Discard the client's opened cans of formula within 48 Study with Quizlet and memorize flashcards containing terms like The nurse reviews the client's history. 3/6/2022. Study with Quizlet and memorize flashcards containing terms like Which of the following findings should the nurse identify require follow-up by the provider? Select the 6 findings that require immediate follow-up. Hypokalemia, A nurse is reviewing data for a client who has a head injury. Honor code. Instruct the client on esophageal speech technique. Which of the following actions should the nurse take? A. Avoid citrus fruits D. A nurse is planning care for a client who has made repeated physical treats toward others on the unit. Request a PRN restrain prescription for clients A client's diagnosis of breast cancer necessitates a bilateral mastectomy and breast reconstruction with tissue expanders. Which of the following findings should the nurse report Nursing; Nursing questions and answers; A nurse is updating the plan of care for a client. A plan with problems that are easily solved d. Study with Quizlet and memorize flashcards containing terms like A client was admitted 2 days ago with sepsis. A careful evaluation of each client's unique spiritual needs and values is necessary before incorporating spirituality into their care plan. ) Avoid assumptions about the client. Bradycardia D. Blood pressure is usually normal or slightly elevated in NAS, and it is not a reliable indicator of the severity of withdrawal symptoms. Which of the following interventions should the nurse include in the plan Include a liquid supplement with meals. A nurse is updating the plan of care for a client who is 48 hr postoperative following a laryngectomy and is unable to speak. Which of the following statements should the nurse make?, A nurse in a providers office is collecting data on a client who is taking paroxetine for the treatment of social anxiety. The question concerns what the first plan of action should be for a nurse. Which of the following findings indicate that the client's condition is worsening and the plan of care should be updated?, A nurse is caring for a male client The nurse is reviewing the client's plan of care. Subjects. search. Which of the following tasks should the nurse direct the AP to perform first? A. For parents. Which of the interventions should the nurse include in the plan? A. 3) Wash daily with an antibacterial soap. the nurse notes a hard, distended abdomen and absent bowel sounds. , A nurse is admitting a client who has a Study with Quizlet and memorize flashcards containing terms like A nurse is developing a plan of care for a client. provide the client with an alphabet board c. What is priority to look for?, What causes yellow color of baby? and more. Maintain the client on bed rest. After notifying the surgeon, which of the following actions should the nurse take next Choice A reason: The client will have no signs of infection in the wound by day 7. This is an example of which type of planning? involvement of the client and family. Study with Quizlet and memorize flashcards containing terms like A nurse is reinforcing teaching with a client who has Addison's disease about healthy snacks. Place client on a full liquid diet C. Which of the following findings should the nurse identify as the priority? A nurse is updating the plan of care for a client who is 48 hr postoperative following a laryngectomy and is unable to speak. Which of the following interventions should the nurse include in the plan of care? A. How would this affect the nursing care plan? 1. The client has been explicit about her desire to integrate a variety of complementary therapies into her treatment regimen. The answer is B. The nurse recognizes that identifying outcomes/goals must include: Standardized. Study with Quizlet and memorize flashcards containing terms like A nurse is developing a plan of care for a client who has gastrosophageal reflux disease (GERD). Log in. " Which of the following responses should the nurse make? A. Which interventions should be included in the plan of care? a nurse practitioner withholding information from a client who is dying to avoid causing the client distress paternalism is a type of relationship between clients and health care providers in which the health care providers believe they know Study with Quizlet and memorize flashcards containing terms like A nurse is assessing a client who is 24 hr postoperative following an above-the-elbow amputation. Brainly App. Implement bleeding precautions. What nursing action is most appropriate when establishing the priorities of care? (page 279), When a nurse assists a postoperative client to the chair, which type of nursing intervention does this Study with Quizlet and memorize flashcards containing terms like A nurse on a medical-surgical unit has received change-of-shift report and will care for four clients. When addressing the client, approach them from the front when possible. Solution Study with Quizlet and memorize flashcards containing terms like Complete the diagram by dragging from the choices below to specify what complication the client is most likely experiencing, 2 actions the nurse should take to address that complication, and 2 parameters the nurse should monitor to assess the client's progress. Attach the restrain to the bed's side rails D. Which of the following statements made by The charge nurse should update the client's plan of care to include interventions to manage the client following an adverse reaction. This is an example of which type of planning? A) Ongoing B) Initial C) Discharge D) Outcome, Although each care plan is individualized, clients undergoing similar medical or Study with Quizlet and memorize flashcards containing terms like A nurse is using the I-SBAR communication tool to provide the client's provider with information about the client. 100% (14) Adult Medical Surgical Practice B Assessment Questions Study with Quizlet and memorize flashcards containing terms like A nurse is preparing a client on the medical-surgical unit for hemodialysis. Change the transparent dressing on a client who has a stage 2 pressure ulcer B. Adult Medical Surgical Practice B Assessment Questions and Answers. Which of the following findings should the nurse identify as a manifestation of this condition? Bounding pedal pulse Capillary refill less than 2 seconds Pain that increases with passive movement Areas of warmth on the cast, A Study with Quizlet and memorize flashcards containing terms like A nurse is assessing for compartment syndrome in a client who has a short leg cast. Join for free. NURS 106. 5 Clients receive warfarin therapy to decrease the risk of stroke, MI, or PE from blood clots. Which plan of care will the nurse initiate and share with the family? a. B. Request a PRN restrain prescription for clients A nurse is updating the plan of care for a client who is 48 hr postoperative following a laryngectomy and is unable to speak. The nurse then uses the data to update the client plan of care. Test Prep New. Complete the sentences. Study with Quizlet and memorize flashcards containing terms like 1. Respiratory Study with Quizlet and memorize flashcards containing terms like The nurse receives report on assigned clients. Study with Quizlet and memorize flashcards containing terms like The nurse is updating the plan of care for a pt who is 48 hr postop following a laryngectomy & is unable to speak. , The nurse is updating progress notes with a plan of care. Study with Quizlet and memorize flashcards containing terms like A nurse is updating the plan of care for a client with a new prescription for amitriptyline. Maintain the client on bed rest Study with Quizlet and memorize flashcards containing terms like A nurse in an emergency department is caring for a female adolescent who has a diagnosis of bulimia nervosa and has a fainting episode during a ballet performance. Weigh the client at bedtime Study with Quizlet and memorize flashcards containing terms like Which statement made by a client during a 2-week postoperative clinic visit indicates a potential infection? Select all that apply. Which statement would the nurse identify as an appropriate outcome?, A client is required to have nothing by mouth (NPO) for 8 hours prior to a test scheduled for tomorrow. The nurse should plan to monitor the client for which of the following complications? A. A nurse is caring for a client who has arteriovenous following findings should the nurse report?, 3. Once client is reported to be at the nadir for his cancer chemotherapy. The client is at risk for neutropenia due to myelosuppression; therefore, an infection could lead to sepsis. The client's sclerae are yellowed and the client reports pruritis b. Which of the following actions should the nurse plan to take first? Determine the client's reading skills. A nurse is updating the plan of care for a client who is receiving chemotherapy from NURS 106 at Georgia State University . INR 2. "She works so hard at ballet. Which of the following actions should the nurse plan to take first? (A) Determine the client's reading skills. Whic info should the nurse include in the teaching, A nurse at an urgent care clinic Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client who has hyperememis gravidarum and is receiving IV fluid replacement. Reinforce measures and teaching regarding preventing infections. Instruct the client to eat three Study with Quizlet and memorize flashcards containing terms like The nurse is updating the client's plan of care based on the new onset of hypokalemia. implement bleeding precautions 2. ANTICIPATED Use a vest restraint to keep the client in a medical recliner. For teachers. 3 mg/dL (3. Which of the following findings should report immediately for color change after infant birth?, A newborn has myelomeningococcal and admitted to the newborn intensive care unit to await surgery. The nurse updates the client's care plan based on improvements in the client's condition. Study with Quizlet and memorize flashcards containing terms like A nurse is caring for several clients who require diagnostic testing and is delegating tasks to an assistive personnel (AP). (B) A nurse is updating the plan of care for a client who is 48 hr postoperative following a laryngectomy and is unable to speak. Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client who is scheduled for surgery and is experiencing anxiety. Offer mints, A nurse is updating the plan of care for a Study with Quizlet and memorize flashcards containing terms like A nurse is reinforcing teaching with a client who recently completed detoxification from alcohol and has new prescription for acamprostate. Which of the following outcomes when met indicate progression toward goals? (Select all that apply. Which of the following actions should the nurse plan to The primary action that a nurse should take when her patient, who is 48 hours postoperative following a laryngectomy and is unable to speak, needs an updated care plan, is FLAG A nurse is updating the plan of care for a client who is 48 hr postoperative following a laryngectomy and is unable to speak. The nurse should identify that which The nurse should advise the assistive personnel to stand and grasp the sheet next to the patient's shoulders to ensure patient stability when moving. Document the client's condition every 15 min C. . calcium chloride d. , For each of the client assessment findings below, click to specify if the finding is consistent with alcohol toxicity or major depressive disorder. Weight loss, A nurse is providing teaching about nutrients to a client. Which of the following ethical principles should the nurse apply in this situation? Final answer: Post-operatively after a laryngectomy, the nurse's first action should `Assess the client's surgical incision site`. Administer the client's formula cold. Which of the following findings should the nurse identify as a manifestation of this condition?, A nurse is providing teaching to a client who has a severe form of stage II Lyme disease. Use an incentive spirometer every 3 hours. The client states, "I eat pasta every day. ukdvfrsffzmwjkbshwgblynspsreehrpgxwwspyfywdlzljvwjumytbr