Question 91 A client with massive trauma and possible spinal cord injury is admitted to the emergency department. Which assessment finding by the nurse will help confirm a diagnosis of neurogenic shock?

Martha is a 77-year-old resident in a nursing home.  Over the past several weeks, she has displayed a gradual decrease in function and safety is now a concern. Staff has begun restraining her in her wheelchair with a posey vest as they are afraid, she will fall should she try to walk without help. At night she is restrained in bed with a roll belt with the side rails up. She is referred to the restraint committee for evaluation and recommendations.  Answer the following questions regarding Martha. The restraint committee has determined that the nursing home will attempt to reduce the amount of restraints used with Martha. Which of the following would be the most appropriate and safe alternative to try?

Question 45 The nurse is caring for a client admitted with a history of diabetes mellitus and the following findings: Complaints of abdominal pain, nausea and vomiting, confusion, fever, flushed dry skin, pH 7.29, Bicarb 12, BP 88/58, RR 38 rapid and deep. Emergency management of this client would include what nursing care? 1. Monitor serum glucose and potassium 2. Ensure a patent airway in the client 3. Begin intravenous insulin drip at 0.2 units/kg/hour 4. Establish intravenous access with a large bore catheter 5. Begin fluid resuscitation with 0.9 NaCl at 1 liter/hour

Question 24 An adolescent tells the school nurse, “My friend threatened to take an overdose of pills.” The nurse talks to the friend who verbalized the suicide threat. The most critical question for the nurse to ask would be:

Question 41 Nursing measures during the care of a client who is currently undergoing the Fluid deprivation test would include which actions? (Select all that apply)

Question 18  The nurse is closely monitoring the intake and output of an infant with heart failure who is receiving diuretic therapy. The nurse should use which most appropriate method to assess the urine output?  

Question 75 A nurse provides preoperative teaching for a client scheduled for coronary artery bypass graft surgery using the internal mammary artery. Which statement by the client indicates a need for further education?  

In the Inpatient Early Mobilization or Phase I of traditional cardiac rehab, a functional capacity assessment would not be completed prior to discharge.

Question 34  A client has just undergone insertion of a central venous catheter by the health care provider at the bedside. Which result should the nurse check prior to initiating infusion of the intravenous solution that has been prescribed?  

The water concentration of an hypertonic solution is ____ and will cause a cell to _____.