of Care/Informatics
Actions the nurse should take when applying prescribed wrist restraints on a client
Secure the restraints using a quick-release tie for easy removal in an emergency; prevent constriction by inserting two fingers under the restraints; remove the restraints at least every 2 hr; secure the restraints to an area of the bed frame that moves with the client when repositioning, and not to the siderails.
The common name for Pertussis.
What is Whooping cough?
The pulse sites the nurse should avoid assessing bilaterally at the same time
What are the Carotid arteries?
An expected lab finding that indicates a patient has an infection.
What are elevated WBC's
An expected BUN level for a client who has dehydration.
What is a BUN of 35 mg/dL?
What to do if a wound eviserates
What is cover the area with a sterile dressing moistened with sterile 0.9% sodium chloride irrigation (AKA normal saline)
The actions a nurse should take to check the pulse of a patient with methicillin-resistant Staphylococcus aureus (MRSA) in an abdominal wound.
What is wear clean gloves?
Action to promote thinning of respiratory secretions.
What is increase oral fluids
A clinical finding of UTIs specifically associated with older adult clients.
What is confusion?
The nurse should expect these findings from a client who has a sodium level of 116 mEq/L.
What is nausea and vomiting, headache, confusion, restlessness and irritability?
Dietary restriction for a Muslim patient
What is no pork
How to open a sterile pack
What is reach around the pack & open the top flap away from the body.
This is an example of nociceptive pain
What is a strained muscle?
Watery red drainage should be documented as this.
What is Serosanguineous?
A patient with hypovolemia would have this type of assessment finding.
What is a weak or thready pulse?
What to do if a patient has not voided in 8 hrs.
What is perform a bladder scan.
Transmission precaution for a patient with C.Diff
What is Contact Isolation?
Hypoxia would lead to this type of heart rate
What is tachycardia?
A chronic rash with leathery skin
What is Atopic Dermatitis
A patient with diarrhea has hypokalemia; what type of assessment finding would a nurse expect?
What is muscle weakness; abnormal heart rhythms (arrhythmias); muscle twitches, cramps
It's why the nurse measures gastric residual.
What is to identify gastric emptying
Priority action the nurse should take for a patient who has a newly applied fiberglass cast for a fractured tibia
What is perform a neurovascular assessment?
A high-pitching squeaking adventitious breath sound
What is wheezing?
A patient presents with scaling and redness between their toes, known commonly as "Athlete's Foot." The medical term for this skin condition is this.
What is Tinea Pedis?
A potential causative factor for a client with a potassium level of 3.0 mEq/L.
What is an NG tube to gastric suction, severe diarrhea, or vomiting, or diuretic medications?