To facilitate healing of the surgical area, a nasogastric tube may be utilized and tube feedings may be implemented.
The client will be unable to maintain any oral intake as long as the tracheotomy is in place.
Nutritional and/or gastric feedings will not be attempted for approximately 3 weeks to decrease the incidence of aspiration.
Because the client is dependent on the ventilator, nutritional intake will be delayed.
Dexamethasone suppression test.
Drug toxicology screen.
Glasgow coma scale.
Client thinking pattern.
Occurrence of hallucinations.
The client has edema of the lower extremities.
Physical exam of the client reveals the presence of lanugo.
The client has ulcerated mucous membranes of the mouth.
The client has dry, yellowish color of the skin.
Evaluate the urine output.
Obtain the client’s weight.
Determine the patency of the IV line.
Measure pulmonary artery pressures.
The nursing assistant answers the phone while wearing gloves.
The nursing assistant log rolls the patient to provide back care.
The nursing assistant places an incontinent pad under the patient.
The nursing assistant positions the patient on the left side, head elevated.
Sore throat, fever, increased fatigue, vomiting, diarrhea.
Dry mouth, nasal stuffiness, weight gain.
Rapid heartbeat, frequent headaches, yellowing of eyes or skin.
Weakness, staggering gait, tremor, feeling of drunkenness.
A patient post coronary artery bypass graft (CABG) having the atrioventricular (AV) wires removed later in the day.
A patient with type 1 diabetes scheduled for a cardiac catheterization later today.
A patient 1 day postoperative with an epidural catheter in place.
A patient diagnosed with cardiomyopathy being evaluated for a heart transplant.
Check the radial pulses bilaterally and compare.
Evaluate the skin temperature and tissue turgor in the area.
Assess sensation of each foot while the child closes her eyes.
Apply baby powder to decrease skin irritation under the cast.
Perform a straight catheterization.
Offer the client the bedpan.
Put the baby to breast.
Massage the uterine fundus.
A small amount of white mucus is aspirated from the NG tube.
The contents aspirated from the NG tube have a pH of 3.
No bubbles are seen when the nurse inverts the NG tube in water.
The client says he can feel the NG tube in the back of his throat.
Client is in the supine position.
The head of the bed is elevated 30 degrees.
The client is lying on the right side.
An eye shield is over the right eye.
Risk for constipation related to immobilization.
Risk for impaired skin integrity related to immobilization and secretions.
Risk for wound infection related to involuntary bowel secretions.
Risk for fluid volume excess related to secretions.
Promote ventilation and prevent respiratory acidosis.
Increase oxygenation and removal of secretions.
Increase pH and facilitate balance of bicarbonate.
Prevent respiratory alkalosis by increasing oxygenation.
Death is punishment for his/her actions.
Death is inevitable and irreversible.
Death is temporary and gradual.
Death as a concept based on past experience.
"It is best to buy new shoes in the morning."
"Have each foot measured every time you buy new shoes."
"Buy shoes a half-size larger than your foot size so the fit is roomy."
"Buy vinyl shoes because they won’t lose their shape easily."
Petal the edges of the cast to prevent irritation.
Elevate the client’s left arm on two pillows.
Apply cool, humidified air to dry the cast.
Ask the client to move the fingers to maintain mobility.
Direct the LPN/LVN to obtain the child’s vital signs.
Ask the mother if the child’s sutures are still intact.
Tell the nursing assistant to take the child for a walk.
Check to see when the child last received pain medication.
High protein, high fat, and high calories.
High protein, low fat, and high calories.
Low protein, low fat, and low carbohydrate.
High protein, high fat, and low carbohydrate.
these tests are valuable screening tests for prostatic cancer.
the level of PSA is decreased in clients with renal stones.
the tests reflect the level of renal involvement in acid-base problems.
the level of PSA is elevated in clients in early-stage renal failure.
Apply warm soaks to the infiltration site, start a new IV, and continue IV medications.
Wait 2 hours, reassess the client, and restart the IV if the client has wheezing or labored breathing.
Restart the IV and continue the previous medication schedule.
Call the physician and recommend that the IV medications be changed to PO.
Provide adequate hygiene and nutrition.
Decrease environmental stimuli.
Slowly involve the client in unit activities.
Administer and monitor sedative and mood-stabilizing medications.
"I have been having difficulty with my hearing."
"I lose my balance easily."
"I can't tell the difference between a sweet and sour taste."
"It is not easy for me to remember names and faces."
A fat-free meal the evening before the examination and radiopaque tablets at bedtime.
Placement of a retention urinary catheter to facilitate dilation of the bladder sphincter.
Cleansing enemas the evening before to provide for adequate visualization of the urinary tract.
Explaining the importance of following directions regarding voiding during the test.
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