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A client is brought to the emergency room by the police. He is combative and yells, "I have to get out of here. They are trying to kill me." Which assessment is most likely correct in relation to this statement?
During a nurse-client interview, the client attempts to shift the session's focus from himself to the nurse by asking the nurse personal questions. The nurse should respond by saying:
A client is admitted to the labor and delivery unit. The nurse performs a vaginal exam and determines that the client's cervix is 5 cm dilated with 75% effacement. Based on this assessment, in which phase of labor is the client? (Note: The latent/early phase is 1-3 cm dilation, the active phase is 4-7 cm dilation, and the transition phase is 8-10 cm dilation.)
A client with severe anemia is to receive a unit of packed red blood cells. In the event of a transfusion reaction, the first action by the nurse should be to:
A client says, "I've done a lot of cheating and manipulating in my relationships." A nonjudgmental response by the nurse would be:
Your patient, who is in a community psychiatric program, shows up at your home peeping through your kitchen window. You also noticed the patient the previous day at the grocery store and at the hairdresser. You believe he is stalking you. What should you do?
An angry patient is in the community room. She picks up a chair and uses it to hit another patient on the head. When you enter the community room, what should your first response be to the patient holding the chair?
The nurse evaluates the ability of a hepatitis B-positive mother to provide safe bottle-feeding to her newborn during postpartum hospitalization. Which maternal action best exemplifies the mother's knowledge of potential disease transmission to the newborn?
All of the following are standard therapy options for cancer treatment EXCEPT:
A student nurse is observing a registered nurse perform a neurological assessment. When the nurse asks the client to "stick out his tongue," the nurse is assessing the function of which cranial nerve?
A toddler is brought to the emergency department with sudden onset of abdominal pain, vomiting, and stools that look like red currant jelly. To confirm intussusception, the suspected cause of these findings, the nurse would expect the physician to order which diagnostic study?
A client is admitted with sickle cell crisis and splenic sequestration. Upon assessing the client, the nurse would expect to find signs of hypovolemia, including which finding?
A nurse is interviewing a preoperative patient who seems anxious and flustered. Which nursing response is inappropriate?
A client has a tentative diagnosis of HELLP syndrome. Which laboratory finding is associated with HELLP syndrome?
When assessing a breastfeeding mother and infant, which finding would be inappropriate, that is, NOT a normal or reassuring sign to look for during the feeding?
Which of the following are appropriate nursing interventions for a postoperative patient who underwent a mastectomy with axillary lymph node dissection? (Select all that apply)
When the nurse and client construct a no-suicide contract, the preferable wording would be:
What is HIPAA, and what does it require of healthcare providers and institutions?
The nurse is caring for a client in labor and is monitoring the fetal heart rate patterns. The nurse notes the presence of episodic accelerations on the electronic fetal monitor tracing. Which action is most appropriate?
The nurse is performing an assessment on a pregnant client with a diagnosis of severe preeclampsia. The nurse reviews the assessment findings and determines that which finding is most closely associated with a complication of this diagnosis?