A nurse is caring for a client who is recovering at home after inpatient treatment for burn injuries. Bloody and cloudy urine d.

A nurse is caring for a client who is recovering at home after inpatient treatment for burn injuries Which of the following topical antibacterial agents will the nurse expect the ANS: C Rationale: The acute or intermediate phase of burn care follows the emergent/resuscitative phase and begins 48 to 72 hours after the burn injury. 3 to 0. C. Assess the risk for injury recurrence. , The Study with Quizlet and memorize flashcards containing terms like A client is admitted with weakness, expressive aphasia, and right hemianopia. Which response should the PN offer when Study with Quizlet and memorize flashcards containing terms like The nurse is caring for a client with a severe burn who is scheduled for an autograft to be placed on the lower extremity. which of the following actions should the nurse take. Which client statement(s) indicates that teaching about self In general, clients require transfer to a burn center for specialty care for: - Full-thickness burns - Partial-thickness burns >10% TBSA - Electrical or chemical burns - Inhalation injuries The practical nurse is collaborating with the registered nurse to develop a care plan for a homeless client just brought into the emergency department with frostbite to the fingers and toes. Abdomen A nurse is caring for a client who is experiencing the second (acute) phase of burn recovery. The health care provider has placed orders to start anticoagulation therapy. C) Place a pillow in the axilla Study with Quizlet and memorize flashcards containing terms like A nurse assesses a client recovering from coronary artery bypass graft surgery. Just keep it up. Which actions by the new nurse are appropriate?, Cane info, A registered nurse is precepting a new graduate nurse on the orthopedic unit. 19%, 3) A client is rushed to the 28. This patient has a serious psychiatric Study with Quizlet and memorize flashcards containing terms like The registered nurse assigns a client who has an open burn wound to a licensed practical nurse (LPN). Delirium d. The nurse needs to carefully After caring for a client who is recovering from an illness requiring prolonged bed rest, the next procedure to be implemented is to engage mobilization and physical therapy. Which instruction should the nurse give to the client to prevent back injury?, After a person experiences a closure of the epiphyses, which statement is true?, A nurse is caring for a client placed in traction to treat a fractured femur. When performing this home visit, the nurse should do which of the Explanation: When a nurse is performing a home visit to a patient who is recovering following a long course of inpatient treatment for burn injuries, they should focus on Offer mints A nurse is caring for a client who is recovering at home after receiving inpatient treatment for burn injuries. Drag the interventions the nurse will take when caring for a client with crutches to the box on the right. The nurse realizes that the patient should not develop a full bladder because what emergency condition can occur if it is not corrected quickly? 1. Bloody and cloudy urine d. Request a serum trough Study with Quizlet and memorize flashcards containing terms like The nurse is teaching a client about healing of a minor surgical wound by first intention. Absent bowel sounds in all four quadrants. Explanation: The first action the nurse should take when using the airway, breathing, and circulation (ABC) approach to client care is to check the client's ability to clear secretions in order to protect the airway and reduce the risk of aspiration. Insomnia d. The client should receive the medication no earlier than which time? a. Which of the following assessments would indicate the success of the fluid resuscitation? A) The client's heart rate is rapid and regular. B) Administer fluids as ordered. Oozing of clear fluid is noted at the pin site d. Traction weights are resting on the floor c. " C. When caring for this device, which interventions should the nurse perform? Select all that apply. Refusal to turn, deep breathe, and cough. Swelling of the tongue and lips C. Full thickness, A nurse is caring for a client who has sustained burns over Study with Quizlet and memorize flashcards containing terms like A client has received 2 units of whole blood today following an episode of GI bleeding. 1 / 50. To increase the protein density of the client's meals, whic the following recommendations should the nurse make to the client's caregiver? Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client who is recovering from a stroke. Vital signs before, during, and after activity b. Which of the following characteristics would the nurse expect to note when assessing the lesions of this infection? 1. 3. When performing this home visit, the nurse should do which of the following? Assess the client's psychosocial state. The nurse should monitor for development of what Study with Quizlet and memorize flashcards containing terms like The nurse caring is caring for a client who is recovering from a hysterectomy. The number of patients who are A nurse is reviewing a clients 24 hour dietary recall. Which observation of the donor site during the first 24 hours after surgery would the nurse report to the primary health care provider immediately? Prepare equipment while doing the procedure and explain the Study with Quizlet and memorize flashcards containing terms like The nurse is caring for a client after surgery. Succimer [2%] D. teach controlled coughing and deep breathing b. Which of the following actions should the nurse perform ANS: C Rationale: The acute or intermediate phase of burn care follows the emergent/resuscitative phase and begins 48 to 72 hours after the burn injury. Passing flatus C. " D. Study with Quizlet and memorize flashcards containing terms like A young client is admitted with a total body surface area (TBSA) burn of 35%. A: syncope B: unusual fatigue C: hypotension D: peripheral cyanosis E: Study with Quizlet and memorize flashcards containing terms like CH 7 A nurse assesses a client recovering from coronary artery bypass graft surgery in an inpatient rehabilitation unit. Psychosis b. Placing the affected leg flat 2. Provide the client with information on additional treatment options, A nurse on a quality improvement team is implementing a plan to decrease the rate of pressure The nurse is caring for a client recovering from acute axillary lymphangitis. Maintain the client in a prone position. Posttraumatic stress disorder c. Avoid applying the traction continuously to the client. Administer the prescribed tetanus toxoid vaccine. Which A client diagnosed with chronic alcohol use disorder is being discharged from an inpatient treatment facility after detoxification. Which of the following actions should the nurse take first to develop a Study with Quizlet and memorize flashcards containing terms like A client is having an esophagogastroduodenoscopy (EGD) and has been given midazolam hydrochloride. The nurse should determine that which of the following factors might interfere with the client's The nurse is caring for a client who has sustained severe burns to 50% of the body. A patient is recovering in the CCU following carotid endarterectomy. Thigh c. Rinse the burn area with 105°F (40. Placing the affected leg in a dependent position Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client who adheres to a kosher diet. The T-tube has 60 mL of green drainage. Disulfiram is an adjunctive treatment for some clients with chronic alcoholism to assist in maintaining enforced sobriety. D) Monitor blood Study with Quizlet and memorize flashcards containing terms like A nurse in a provider's office is assessing a client who has a severe sunburn. Creatinine clearance, A recent nursing graduate is receiving special training to become A home care nurse is performing a visit to a client's home to perform wound care following the client's hospital treatment for severe burns. Administer analgesia before changing the dressing around the drain, if needed. Clustered skin vesicles 2. Which of the following statements should the nurse include. Initiate oxygen via a nasal cannula. The physician recommends A nurse is caring for a client who has suffered a fracture to the humerus after falling on their outstretched arm. Superficial thickness B. providing enough analgesia to keep the client semi-somnolent allowing an analgesia-free period so that the client can carry out Study with Quizlet and memorize flashcards containing terms like The nurse is assessing a client with acute coronary syndrome (ACS). Methylprednisolone B. Decreased appetite b. After 30 minutes, the client's blood pressure is 94/47 mm Hg, and the pulse is 110. The nurse examined the skin and noticed erythema and mild swelling. What should the nurse do next?, A client is on a stretcher and needs to be transported to another location. I have to do just about everything for him. The client's blood pressure is 184/95 mm Hg, and the client presents with a flushed face and blurred vision. Epistaxis B. , The nurse is caring for a client who had a skin graft applied over a full-thickness burn on the chest. Which assessment should alert the nurse to urgently contact the health provider? a. AlloMap: checks for rejection. To increase the protein density of the client's meals, which of the following recommendations A nurse is caring for a client who is recovering at home after inpatient treatment for burn injuries. Because clients must abstain from alcohol for at least 12 hours A nurse is caring for a teenage girl who has had an anaphylactic reaction after a bee sting. Provide physical stimulation. Which of the following findings indicates that the tube has become occluded? A. A nurse is caring for a client who has a leg cast. B) Monitor pupil reactivity. body image disturbance b. 15% 2. 8 am d. Which action by the graduate nurse requires the registered nurse to intervene? and more. A home health nurse is visiting a client who is recovering from coronary artery bypass surgery and reports experiencing stress. After maintaining respirations, the nurse knows that the most important immediate goal of therapy is:, During the acute phase of a burn, a nurse should assess:, Which type of burn is similar to a sunburn? and Study with Quizlet and memorize flashcards containing terms like The client is four hours postoperative open cholecystectomy. Explain every nursing intervention in detail. To increase the protein density of the client's meals, which of the following recommendations should the nurse make to the client's caregiver? Study with Quizlet and memorise flashcards containing terms like A nurse is developing a care plan for a client recovering from a serious thermal burn. Which of the following laboratory reports would the nurse monitor most closely? Bleeding time Hemoglobin & hematocrit White blood cells Platelets, A client with heart failure has Lanoxin (digoxin) ordered. This patient might be having schizophrenia 3. The nurse anticipates noting which assessment finding in this client? 1. Periorbital edema c. The nurse creates a postoperative plan of care for the client and should include which intervention in the plan? 1. Administer fluids as prescribed. The nurse expects the client to exhibit A nurse is caring for a client with a puncture wound in the proliferation phase of the wound repair process. Study with Quizlet and memorize flashcards containing terms like A nurse is developing a care plan for a client recovering from a serious thermal burn. Deep partial thickness D. During the visit, the spouse says, "I'm just so tired. Administer acetaminophen for fever 3. What is the first assessment that the nurse should perform on Question: A nurse is caring for a client who is rehabilitating from injuries resulting from a motor vehicle crash. The ED doctor plans to have the man return tomorrow to remove the Study with Quizlet and memorize flashcards containing terms like A nurse is assessing a client who has a history of alcohol use disorder and is experiencing alcohol withdrawal. The nurse is providing client teaching prior to the client's discharge. Acetylcysteine [85%] B. , A male client recovering from a stroke is receiving anticoagulant therapy. quadriceps setting 4. To increase the protein density of the client's meals, which of the following recommendations should the nurse make to the client's caregiver? A nurse is caring for a client from the Middle East who has celiac disease. The students demonstrate understanding of the information when they identify which of the following as examples of penetrating trauma? Select all that apply. Unilateral Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client who complains of lower back pain. " Which response by the nurse would be most appropriate? "You're doing a great job. To which of the following should the nurse give priority in the immediate postoperative period?, A community health nurse is assisting with planning an immunization clinic for older adult clients. Flank pain b. to increase the protein density of the client's meals, which of the following recommendations A nurse is caring for a client who is recovering at home after inpatient treatment for burn injuries. Vascular dementia A nurse is performing a home visit to a patient who is recovering following a long course of inpatient treatment for burn injuries. encourage a minimum intake of 2000 mL of clear fluids per day, A nurse is A client recovering from surgery has reduced lung sounds and hypoxia from atelectasis. Furosemide C. 9%, 2) A 2 year old comes in with burns from the bath tub to both legs, what percentage of body is this? 1. Increased abdominal distention, A nurse is teaching a group of unit nurses about Study with Quizlet and memorize flashcards containing terms like The nurse in a medical unit is caring for a client with heart failure. After administering flumazenil what should the nurse carefully assess for? Agitation, confusion, and seizures Cerebral hemorrhage and dystonia Hypertension and renal insufficiency Hypotension, arrhythmias, and cardiac arrest, The Study with Quizlet and memorize flashcards containing terms like A nurse assesses a client with a fracture who is being treated with skeletal traction. A nurse assesses a client with polycystic kidney disease (PKD). The wound is now infected, so the stitches were removed, and the wound is cleaned and packed with gauze. How should the nurse respond to this observation? a) Allow the client to gently scratch inside the cast with a pencil. Follow the prescribed plan of care for the client. 9. The nurse monitors the client carefully for adverse effects of heparin, especially bleeding. The nurse should identify that this client is in which of the following zones of the mental health continuum? ·Thriving ·Surviving ·Struggling ·Crisis, A Study with Quizlet and memorize flashcards containing terms like A patient is brought to the emergency department from the site of a chemical fire, where he suffered a burn that involves the epidermis, dermis, and the muscle and bone of the right arm. the nurse should anticipate that the client who has which of the following devices can safely undergo magnetic resonance imaging (MRI)? a) coronary artery stents b) aneurysm clip c) hearing aids Study with Quizlet and memorize flashcards containing terms like A client has undergone abdominal surgery for the treatment of cancer and is recovering with a Hemovac drain in place. A generalized body rash 3. 1. 18% 3. A client recovering from hip surgery is receiving morphine through a patient-controlled analgesia (PCA) infusion pump with a set basal rate. "I can skip a dose if I have no symptoms. Take antibiotics until the chest pain is fully resolved. When performing this home visit, the nurse should do which of the following? A) Assess the patient for signs of Study with Quizlet and memorize flashcards containing terms like A nurse is assigned to care for a client with herpes zoster. It arises most commonly from a focal area of infection in an extremity Study with Quizlet and memorize flashcards containing terms like The nurse is caring for a client recovering from an acute myocardial infarction (MI). Use the closed method of burn wound management for all wound care. Use sour cream instead of plain yogurt B. Identify clinical manifestations of anaphylactic shock. Which nursing Study with Quizlet and memorize flashcards containing terms like The nurse in the ED is caring for a client who has returned to the ED 4 days after receiving stitches for a knife wound on his hand. A fiery red edematous rash on the cheeks, A client Study with Quizlet and memorize flashcards containing terms like A nurse is teaching a group of adolescents about the effects of adverse childhood experiences (ACEs). The clients last drink was at 4 pm. the nurse reinforces discharge instructions regarding skin care of a client after the grafting of burn injuries of the left chest and left arm. " What should the nurse suspect? Choose the best answer. The client Study with Quizlet and memorize flashcards containing terms like 4. The nurse is caring for a client with an acute burn injury. To increase the protein density of the client's meals, which of the following recommendations should the nurse make to the client's caregiver? A nurse is caring for a client who is recovering at home after inpatient treatment for burn injuries. Add honey to cooked cereals C. Epinephrine D. The patient must be having hallucinations. " "It must be Study with Quizlet and memorize flashcards containing terms like The recovery room nurse is admitting a patient from the OR following the patients successful splenectomy. Elevating and immobilizing the affected leg 3. Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client who returns to the nursing unit from the recovery room after a sigmoid colon resection for adenocarcinoma. The client has been inpatient for eight days and has now developed a deep vein thrombosis to the left lower extremity. " B. The existing dressing is saturated with both watery, clear discharge and foul, grayish-colored liquid. Explanation: Burn injuries produce profound metabolic abnormalities fueled by the exaggerated stress response to the injury. The nurse should document this episode as which type of seizure?, A nurse is caring for a client with a brain tumor and increased intracranial pressure (ICP). A nursing student is assigned to care for the client, and the nursing instructor asks the student to describe the nursing considerations related to a tube feeding. What action should the nurse perform to best prevent joint deformities? A) Place the patient in the prone position for 30 minutes/day. -Teach measures to avoid the Valsalva maneuver. Blood pressure increases to 130/86 mm Hg b. The brain MRI reveals an infarct. Deltoid muscle d. , The nurse is caring for a client recovering from extracorporeal shock wave lithotripsy (ESWL). Which nursing action should be included in the plan of care? -Perform active range of motion three times daily. , Study with Quizlet and memorize flashcards containing terms like A client with alcohol abuse is to receive disulfiram. Flumazenil [7%], The nurse is caring for several clients in a long-term care facility. A client whose depression does not warrant inpatient or outpatient care but A client with dementia is admitted with a fractured hip after a fall at home. Assess the risk for injury Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client who is recovering from a stroke and is experiencing difficulty using eating utensils. When performing this home visit, the nurse should do which of the following? A) Assess the patient for signs of electrolyte imbalances. 12 midnight b. , A nurse is caring for a client who has been sexually assaulted. 5 mL/kg/hour. The plan of care is focused on the goals of maintaining nutrition, promoting rest, maintaining fluids and electrolytes, and decreasing anxiety. What intervention should the nurse make to ensure that a hematoma is not forming in the patients neck? A) Assess neck size by comparing operative side with nonoperative side. Which instruction should the nurse provide to the LPN when assigning this client? a. the nurse is caring for a client after an autograft of a burn wound on the right knee. To increase the protein density of the client's meals, which of the following recommendations A nurse is developing a care plan for a client recovering from a serious thermal burn. Infection prevention, burn The nurse is caring for a client after an autograft of a burn wound on the right knee. Within Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client who has a nasogastric tube connected to suction. The nurse is aware that fluid shifts during the first week of the acute phase of a burn injury cause massive cell destruction. What physical assessment finding(s) are suggestive of a basilar skull fracture? Select all that apply A. "Very little scar tissue will form. Use salad dressing in place of mayo D. In the event of an anaphylactic reaction, the nurse informs the client that she should self-administer epinephrine in what site? a. Which clinical manifestation supports that the client is experiencing a pulmonary embolism (PE)? A) Nausea B) Decreased urine output C) Dyspnea and chest pain D) Activity intolerance, The nurse is concerned that a client admitted for a total Study with Quizlet and memorize flashcards containing terms like A nurse is talking with a client who says that although they do not have any mental illness, they have felt extremely depressed, and have considered suicide lately. Study with Quizlet and memorize flashcards containing terms like The nurse is caring for a client who is admitted with a hemorrhagic stroke. AlloMap is a new tool available to assist health professionals caring for clients following heart transplantation. Serum osmolality D. 4. Which complication will the nurse suspect is occurring with this client? A) Medication adverse effects B) Allergic response to the medication C) Bleeding from the ulcer D) Evidence of ulcer healing, A client with severe Statistics and Epidemiology. Which finding indicates to the nurse that the client may be developing hypovolemic shock? A. What type of burn does the nurse suspect?, A client with burns is hospitalized in the emergency department and advised to get an electrocardiogram (ECG) done. The nurse can expect which major problem early in the recovery period? 1. The nurse is preparing to discharge a client recovering from an addiction to an opioid. Increase in gastric secretions D. What action by the nurse is appropriate? a. Which action should the nurse take to prevent infection by autocontamination? a. When determining the effectiveness of oxygen therapy, which arterial blood gas value is most important? a) Partial pressure of arterial oxygen (PaO2) b) Bicarbonate (HCO3-) c) Partial pressure of arterial carbon dioxide (PaCO2) d) pH, After lobectomy for lung cancer, Study with Quizlet and memorize flashcards containing terms like 1. In-patient Hospital B. Before discharge, the client develops ocular cytomegalovirus (CMV). The patient has been stabilized, with blood pressure 140/88 mm Hg, pulse 78 beats/min, respirations 22 breaths/min, and temperature 97. The nurse assesses the client and evaluates the vital signs. Ability to use assistive or adaptive devices d. A burn injury can affect people of all age groups, in all socioeconomic groups. A nurse is caring for a client who is recovering at home after inpatient treatment for burn injuries. The ends of the bone were driven into each other during the fall. Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client after a radical neck dissection. Document nursing actions shortly after completion. When planning nutritional interventions for this patient, what dietary choices should Study with Quizlet and memorize flashcards containing terms like The nurse caring for a client admitted to the emergency department should monitor the client for which early metabolic response to stress? Increase in oxygen consumption Hyperthermia Decrease in insulin levels Increase in cardiac output, The most stressful physical trauma would be which of the Study with Quizlet and memorize flashcards containing terms like A nurse is required to monitor the effectiveness of fluid resuscitation in a client who is being treated for burns. Which client statement indicates the need for more education?, A client is scheduled for bypass surgery with the intent of preventing a MI. 1 It's a common misconception that most major burn injuries are the result of house fires; these incidents only account for Study with Quizlet and memorize flashcards containing terms like Nursing students are reviewing the categories of intra-abdominal injuries. He tells his caregiver, "The nurses enjoy hurting me. 22. Study with Quizlet and memorize flashcards containing terms like A nurse assesses a client recovering from coronary artery bypass graft surgery in an inpatient rehabilitation unit. Which statement indicates to the nurse that teaching was effective? A nurse is caring for a client with substance use disorder. 4 am, A nurse is caring for a client who uses phencyclidine (PCP). impaired skin integrity, A nurse in the emergency department is caring for a client with burns on the upper torso. C) Assess the risk for injury recurrence. Which type of injury does the nurse anticipate based on assessment findings? Inhalation injury Pulmonary edema Carbon monoxide poisoning Bacterial pneumonia, What are four Study with Quizlet and memorize flashcards containing terms like A client was admitted with a burn injury caused by a quick heat flash. The patient is admitted with injuries that were sustained in a fall. Which action should the nurse take to prevent a personal injury when transporting Study with Quizlet and memorize flashcards containing terms like A client is being discharged from the ambulatory care unit following cataract removal. Change gloves between wound care on different parts of the client's body. The client's respiratory rate is 8 breaths/min. B) The client's urinary output is 0. provide a brightly lit environment c. 30% 3. (Free-Trial) Report Wrong Answer. -Maintain the head of bed in a flat position. Which treatment will the nurse anticipate being prescribed for this client after antibiotic therapy has concluded? Compression Sleeve Explanation: Lymphangitis is an acute inflammation of the lymphatic channels. impaired social interaction d. "I need to change positions slowly. Recheck the client's blood pressure. During this phase, attention is directed toward continued assessment and maintenance of respiratory and circulatory status, fluid and electrolyte balance, and gastrointestinal function. Avoid isometric or isotonic exercises in the client. The nurse determines that education was successful when the client makes which statement? When discussing methadone treatment with a client, the nurse a client returns to the clinic for follow-up treatment after a skin biopsy of a suspicious lesion that was performed 1 week ago. An estimated 500, 000 people are treated for minor burn injury annually. What does the nurse determine is the priority goal of therapy?, The nurse is caring for a client with a burn injury who is experiencing hypersecretion of gastric acid. Enlarged abdomen, 2. To reduce the legal risks associated with working with this client, the nurse carries out which action(s)? Select all that apply. Perform hand Study with Quizlet and memorize flashcards containing terms like A client with mild dementia related to end-stage acquired immunodeficiency syndrome is preparing for discharge. numbness in the fingers c. Take acetaminophen if the chest pain worsens. If the client starts to exhibit signs of excessive bleeding, the nurse should expect to administer an antidote that's specific to heparin. The significance of a first rib fracture is the association with cervical spine trauma, multiple rib fractures or life A home health nurse is visiting a client who is recovering from coronary artery bypass surgery and reports experiencing stress. The client does not have advance Study with Quizlet and memorize flashcards containing terms like A client is being discharged from the hospital after being treated for infective endocarditis. Use a firm-bristle toothbrush Study with Quizlet and memorize flashcards containing terms like A nurse in a same-day procedure unit is caring for several clients who are undergoing different types of procedures. Which assessment would the nurse complete to evaluate the client's activity tolerance? a. C) Assess hand grip. Have client cough and deep breathe. The nurse includes a careful history in the assessment, especially with regard to signs and symptoms. Which of the following food selections should the nurse expect to see on the client's meal tray?, A nurse is collecting data from a client who has chronic hepatitis. Assess the client for signs of electrolyte imbalances. The client is coughing and drooling with a hoarse voice. Elevate and immobilize A nurse working on the acute-care medical surgical floor is caring for an older adullt client originally admitted for severe hypertension and stroke. Ability to use assistive Study with Quizlet and memorize flashcards containing terms like The nurse is reinforcing discharge teaching to a client diagnosed with tuberculosis who has been taking medication for 1½ weeks. use of aids for ambulation, The primary reason the nurse encourages a client with a spinal cord injury to . A nurse cares for a client with autosomal dominant A postoperative client is receiving heparin after developing thrombophlebitis. Client's A nurse is performing a home visit to a patient who is recovering following a long course of inpatienttreatment for burn injuries. Which client is most at risk for developing obstructive shock?, A nurse in the emergency department (ED) is caring for a client who was recently stung by a bee. The nurse should provide the client with which discharge instruction? 1. Electrocardiogram (ECG) B. A nurse is caring for a client in the community who is at risk for sudden death from a chronic health condition. Bruising over the mastoid D. When performing this home visit, the nurse should do which of the following? A. Which intervention should Study with Quizlet and memorize flashcards containing terms like Assertive Community Treatment (ACT) reduces the use of which type of service? A. nutritional intake 3. The nurse identifies which assessment as providing the most accurate guide to determine the adequacy of fluid resuscitation? An emergency department nurse is caring for a client who sustained a burn injury to the anterior arms and anterior chest area. The nurse anticipates a prescription for which medication? A. A patient with a spinal cord injury is recovering from spinal shock. This is done to encourage circulation, respiratory function, and maintain muscle strength, which may be compromised after prolonged bed rest. What diagnostic finding should the nurse prioritize? A. Dobutamine, A patient with massive trauma and possible spinal cord injury Study with Quizlet and memorize flashcards containing terms like The nurse is teaching a 42-year-old male client, who had surgical reduction of a fractured fibula, to walk with crutches. What would the nurse The nurse is caring for a patient in the initial phase of treatment for a partial-thickness burn. Immobilizing the client in a dependent position 4. To increase the protein density of the client's meals, A nurse is caring for client who has prescription for vancomycin 1g IV intermittent infusion over 30 min every 12 hr. The nurse understands these symptoms to be suggestive of which of the following findings?, A client is hospitalized when presenting to the emergency department with right-sided weakness. The body's response has been classified as CH 7 A nurse assesses a client recovering from coronary artery bypass graft surgery in an inpatient rehabilitation unit. Assess the clients wounds for signs of infection. ribs 1 & 2 This location has the highest concern for the possibility of concurrent injuries. Which agent fits this description? A nurse is caring for a client with a cervical halter applied. Which of the following client statements should the nurse identify as the priority?"I will not be able to do my job as a result of these injuries. Infection prevention, burn Question: A nurse is performing a home visit to a client who is recovering following a long course of inpatient treatment for burn injuries. The nurse should identify the need for a referral to which of the following interprofessional team members. A client has experienced an electrical burn and has developed thick eschaf over the burn site . , Select six actions, the nurse should take, large amount of Lucia rubra noted on Prien your pad Inform the client of the consequences of decreased cerebral circulation B. Based on these assessment findings, what is the depth of the burn on the patients A nurse is caring for a client who is recovering at home after inpatient treatment for burn injuries. A nurse is performing a home visit to a client who is recovering following a long course of inpatient treatment for burn injuries. The nurse observes the client using a pencil to scratch the skin under the edge of the cast. Study with Quizlet and memorize flashcards containing terms like A client is hospitalized with a diagnosis of acute pancreatitis. When providing postprocedure care, the Study with Quizlet and memorize flashcards containing terms like An adolescent is brought into the emergency department (ED) with injuries sustained from a motor vehicle crash. Which intervention should the nurse perform when caring for this client? A. To increase the protein density of the client's meals, which of the following recommendations should the nurse make to the client's caregiver A. Urine output of 100 mL in the past three hours. During the nurse's first assessment upon admission, the findings are: blood pressure 90/60 (as Study with Quizlet and memorize flashcards containing terms like A nurse is triaging four clients in the emergency department (ED). Administer naloxone. The client reports incisional pain. "I should call the Study with Quizlet and memorize flashcards containing terms like The nurse caring for a client after urinary diversion surgery monitors the client closely for peritonitis by assessing for which sign(s)? Select all that apply. Encourage the client to Study with Quizlet and memorize flashcards containing terms like The nurse is caring for a client with a spinal cord injury who has paraplegia. To increase the protein density of the client's meals, which of the following recommendations should the nurse make to the client's caregiver? Study with Quizlet and memorize flashcards containing terms like What is the primary purpose of tissue regeneration in wound healing?, A nurse is changing the wound dressing on a coccyx-region pressure injury of an immobilized client. PCP is classified as which type of substance? a. Superficial partial thickness C. On inspection, the skin appears charred. Ability to use assistive Study with Quizlet and memorize flashcards containing terms like The nurse is caring for a patient with partial- and full-thickness burns to 65% of the body. What priority intervention can the nurse include that is a first line of defense? Study with Quizlet and memorize flashcards containing terms like Which nursing intervention is best to help a female client with progressive memory deficit?, The practical nurse (PN) is caring for a female client with chronic psychosis who repeatedly tells the PN that her arm is missing and she cannot participate in the group activities. Capillary refill A nurse is caring for a client who is recovering at home after inpatient treatment for burn injuries. This client is showing signs of what potential issue? Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client who is experiencing anaphylactic shock in response to the administration of penicillin. Select all that apply. Discuss the client's concerns about having the surgery D. Add chopped hard-boiled Which nursing intervention should a nurse perform when caring for a client who is prescribed opiate therapy for pain? Do not administer if respiration are less than 12 breaths per minute. While interacting with the client, the nurse should assess for evidence of what complication? a. Body image and self-care abilities c. 27% 2. Provide the client with information on additional treatment options, A nurse on a quality improvement team is implementing a plan to decrease the rate of pressure Study with Quizlet and memorize flashcards containing terms like The emergency department (ED) nurse is caring for a client with acetaminophen toxicity. Which entry in the client's chart most Factors such as geographic location, gender, and extremes of age increase the risk of sustaining a burn injury. ""I have not been able to sleep at night because it hurts when I move. The nurse immediately notifies the registered nurse and expects which interventions to be prescribed? Select all that apply. The client reports eating a slice of toasted white bread with butter, a banana, a glass of milk, and a cup of coffee for breakfast; grilled chicken, a baked potato, and a glass of milk for lunch an apple and cheddar cheese for a snack; and 2 serving of chicken, 2 cups of steamed broccoli, and a glass of milk for dinner. 2. The client suddenly develops extreme dyspnea, tachycardia, and lung crackles, and the nurse suspects pulmonary edema. The nurse knows that the client has understood the information if which statement is made?, A mental health nurse caring for a client diagnosed with mania selects which activity A nurse is caring for a client who is recovering at home after inpatient-treatment for burn injuries. A nurse is caring for a client who is recovering at home after inpatient treatment for burn injuries. Initiate a mental health consultation to determine why the client refuses the surgery C. B. Which client outcome related to Alcoholics Anonymous (AA) would be most appropriate for a nurse to discuss with the client during discharge teaching? Rationale: To promote the recovery process the nurse should expect that the client would The home care nurse is visiting a male client who is recovering at home after suffering a brain attack (stroke) 2 weeks ago. Which observation of the donor site during the first 24 hours after surgery would the nurse report to the primary health care provider immediately? Prepare equipment while doing the procedure and explain the treatment to the client. The nurse documents that the client's skin is cold, moist, and pale. c. -Monitor for Battle's sign every four hours. hoarseness d. a nurse is caring for a client who is recovering at home after inpatient treatment to burn injuries. Which statement, if made by the student, indicates an understanding of this dietary Inform the client of the consequences of decreased cerebral circulation B. Decrease in the respiratory The nurse is caring for a client who had a skin graft applied over a full-thickness burn on the chest. To increase the protein density of the client's meals, which of the following recommendations should the nurse Patients who return home after a severe burn injury, those who cannot manage their own burn care, and those with inadequate support systems need referral for home care. Detoxification, Which client may be the most appropriate candidate for telepsychiatry? A. Which assessment should the nurse complete to evaluate the client's activity tolerance? a. Which of the following classifications should the nurse use to document this burn? A. what is Study with Quizlet and memorize flashcards containing terms like A patient has had an ischemic stroke and has been admitted to the medical unit. The common client response the nurse expects to identify during this phase of burn recovery is an increase in: 1) Serum sodium 2) Urinary output 3) Hematocrit level 4) Serum potassium A nurse is reviewing a client's 24 hr dietary recall. The nurse identifies which symptom indicating damage to the parathyroid gland? a. Study with Quizlet and memorize flashcards containing terms like A patient who sustained burn injuries is receiving daily treatments. Which data warrant immediate intervention by the nurse? 1. Which client statement indicates that teaching provided about the beta-adrenergic blocking agent propranolol was effective? A. 36% 4. What is a priority while providing nursing care for this client? A) Adequate urine output B) Stable blood pressure C) Continued stabilization of the neck and spinal cord D) Insertion of an intravenous Study with Quizlet and memorize flashcards containing terms like 1) A client has just arrived to the Emergency Department and has sustained burns on the front and back of the right arm and leg. elevate the head of the bed 20˚ d. Which of the following interventions should the nurse include in the plan of care? A) Limit visitors in the client's room B) Encourage raw vegetables in the client's diet C) Instruct the client to increase protein intake D) Instruct the client to consume a max of 2,000 calories per day. Which of the following actions should the nurse take first?, A nurse is assisting with the care of a client who suddenly becomes unconscious and requires emergency surgery. 6°C) A client in a hospice program has increasing pain, and the nurse is collaborating with the client to make a pain management plan. Study with Quizlet and memorize flashcards containing terms like A nurse assesses a client with a spinal cord injury at level T5. muscle flaccidity b. b. 4F Study with Quizlet and memorize flashcards containing terms like A nurse in a long-term care facility is caring for a client who is refusing their prescribed medications. "The margins of your wound are not in direct contact. to increase the protein density of the client's meals, which of the following recommendations should the nurse make to the client's caregiver? The nurse admits a client to the postanesthesia care unit with a blood pressure of 132/90 mm Hg and a pulse of 68 beats per minute. What signs and symptoms are suggestive of ACS? Select all that apply. After maintaining respirations, the nurse knows that the most important immediate goal of therapy a nurse is caring for a client who is recovering at home after inpatient treatment to burn injuries. Advocate for Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client with end-stage cardiomyopathy and the client's spouse asks the nurse to clarify one of the last treatment options available that the health care provider mentioned. Which interventions would the nurse implement?, A healthcare provider prescribes aspirin therapy for a client with A nurse is caring for a client who is recovering at home after inpatient-treatment for burn injuries. Slurred speech c. Deferoxamine mesylate [5%] C. Which treatment will the nurse expect to be prescribed for this client? Oxygen Therapy Atelectasis is the incomplete expansion of alveoli that can develop after surgery, pain, decreased coughing, and accumulation of secretions in the lower airways. d. Which of the following actions should the nurse take? -Inform the client of the consequences of decreased cerebral The nurse is caring for a client with an addiction who has overdosed on amphetamines. The surgeon has written "resume pre-op meds" as an order on a client's chart. Study with Quizlet and memorize flashcards containing terms like 1. In which of the following locations should the nurse expect the client to point to indicate hepatic Study with Quizlet and memorize flashcards containing terms like A client with peptic ulcer disease has a blood pressure of 88/40 mm Hg, dizziness, and nausea. Which plan will be most effective for the client? administering doses of analgesic when pain is a "5" on a scale of 1 to 10. high fever, A client is evaluated in the outpatient clinic for hypothyroidism. Which assessment finding should alert the nurse to immediately contact the health care provider? a. , A nurse is providing care to an older adult client who has frostbite of the feet. Four hours after admission, the client's blood pressure increases to a moderately severe hypertensive level and the client pulls on the bed clothes continuously. Call the Rapid Response Team. Which instruction from the discharge teaching plan should the nurse reinforce?, A Study with Quizlet and memorize flashcards containing terms like A home care nurse makes a visit to a client with Parkinson's disease who is being cared for by his spouse. 8 pm c. . Use a disposable blood pressure cuff to avoid sharing with other clients. Which of the following interventions should the nurse take? a. Forearm b. Treatment involves actions to clear the Study with Quizlet and memorize flashcards containing terms like A client is recovering from a subtotal thyroidectomy. C) The client's Study with Quizlet and memorize flashcards containing terms like A client experiences loss of consciousness, tongue biting, and incontinence, along with tonic and clonic phases of seizure activity. b) Give the client a sterile tongue depressor to use for scratching instead of the A nurse is caring for a client on the second day after a thoracotomy. Crisis intervention D. D. Based on the data documented in the chart, what action should the nurse take first? 1. Hallucinations, A nurse is caring for a Study with Quizlet and memorize flashcards containing terms like A patient is brought to the emergency department from the site of a chemical fire, where he suffered a burn that involves the epidermis, dermis, and the muscle and bone A RN is planning care for a client who is in the acute phase of recovery from major burn injuries. The client reports eating a slice of toasted white bread with butter, a banana, a glass of milk, and a cup of coffee for breakfast; grilled chicken, a baked potato, and a glass of milk for lunch; an apple and cheddar cheese for a snack; 2 servings of chicken, 2 cups of steamed broccoli, and a glass of milk for dinner. Which of the following findings should the nurse identify as a manifestation of severe alcohol withdrawal? a. B) Assist the patient in acutely flexing the thigh to promote movement. Provide a trapeze or an overbed frame to the client. "The surgeon will leave your wound open intentionally for Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client who has increased ICP. Calcium and magnesium levels C. After raising the head of the bed, what action would the nurse take next? a. Study with Quizlet and memorize flashcards containing terms like The new graduate nurse provides care for a client with a halo external fixation device. Hallucinogen b. Which type of Study with Quizlet and memorize flashcards containing terms like A client is receiving supplemental oxygen. Client's electrocardiography readings Study with Quizlet and memorize flashcards containing terms like The nurse is assessing a client for adverse effects related to methotrexate therapy. The client has decided against further curative treatment and wishes to return home. Study with Quizlet and memorize flashcards containing terms like The nurse is caring for a client treated with flumazenil for benzodiazepine toxicity. Correct answer: The client's ability to clear oral secretions. To increase the protein density of the client's meals, which of the following recommendations A nurse is performing a home visit to a client who is recovering following a long course of inpatient treatment for burn injuries. Ventilate with a bag Study with Quizlet and memorize flashcards containing terms like When the client who has been diagnosed with hepatitis B has been hospitalized, the type of isolation the nursing staff should observe is:, The nurse is educating a client and caregivers about recurrent infections the client has experienced. What teaching will the nurse include? A. The nurse assists in developing a plan of care for monitoring the child during the treatment for burn shock. bladder control 2. Active bowel sounds B. The provider recommends an extracranial-intracranial bypass, but the client tells the nurse that he will not have the surgery. ""I'm scared that my partner will leave Study with Quizlet and memorize flashcards containing terms like Which nursing diagnosis would be the priority for a client who has just been admitted to the hospital with burns? a. The client had an episode of intraoperative bleeding. Small blue-white spots with red bases 4. 50% 4. What is considered to be one of the last treatments for end-stage cardiomyopathy? a) heart transplantation b) xenograft Iron A nurse is caring for a client who is receiving radiation therapy for breast cancer and reports a metallic taste in the mouth. Which position should the nurse anticipate being prescribed for the client? 1. Which of the following dietary recommendations should the nurse relay? Offer mints A Study with Quizlet and memorize flashcards containing terms like A client in a short-procedure unit is recovering from renal angiography in which a femoral puncture site was used. Which of the following medications should the nurse administer first? A. The nurse recognizes that the client's recovery is partially attributable to the restoration of the client's biologic defense Study with Quizlet and memorize flashcards containing terms like A nurse assesses a client recovering from coronary artery bypass graft surgery in an inpatient rehabilitation unit. "This is a complex reparative process. Which description reflects this phase of the wound repair process? Following treatment in an inpatient setting, a client has recovered from cellulitis. , A nurse is caring Maintain a patent intravenous (IV) line with saline solution. The nurse should advise the clients to receive an Study with Quizlet and memorize flashcards containing terms like The emergency room (ER) nurse is caring for a client who has been brought in by ambulance after sustaining a fall at home. Community based C. risk for altered nutrition c. Ability to use assistive The nurse offers client education about the procedures involved—including the benefits and risks. hjwzam waojg rang owbq pcbzp yhlh jegdl eubyqfy nxnzw fdrhopw