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AP task postoperative measure drainage
noncompliance with advance directives administration of enteral tube feedings who has end-stage dementia who has advanced directive that say comfort measures only
how to identify true labor cervix transitions to an anterior position
above the knee amputation plan of care assist the patient to the prone position NO ELEVATION
AP assist with meals demonstrating aphasia
chemotherapy further teaching needed regarding precautions fresh fruits and veggies
radiation therapy, prostate cancer, expected side effects- understanding of teaching I can wash the irradiated area with a mild soap and water
indwelling catheter for male- sterile technique set catheter tray on the overhead table at waist height
prescribed home oxygen therapy understanding of teaching wear cotton fabrics oxygen in use smoking outside
grapefruit and verapamil what are the s/s tachycardia
assessment of a newborn following a vaginal delivery nasal flaring? overlapping of sutures
fire safety RACE
current staffing issues, acceptance of change the nurse manager should encourage staff to offer possible solutions
gestational diabetes- include in teaching at birth your baby will be at risk for hypoglycemia
lorazapem- which antidote would you give for respiratory depression flumazenil
severe preeclampsia following s/s blurred vision facial edema proteinuria
intervene which HIPAA violation chaplain and client diagnosis
clients rights and informed consent- ethical principles autonomy
hepatitis A cleaning 1:100 chlorine solution
discharge teaching who has a new diagnosis of TB remain on medications for 6 months
unconscious following an injury proceed with medical care "implied consent"
acute exacerbation of asthma peak expiratory flow rate
ICP medication mannitol
CVA referral to OT difficulty performing personal hygiene
tracheostomy final step change trach ties
RA moderate to severe pain in multiple joints allow frequent rest periods
informed consent nurses role witness
child safety measures always wear a helmet
fecal impaction insert a lubricated gloved finger
glomerulonephritis expected finding in urine protein
dietary teaching for 7 month introduce new foods 4-7 days at a time
patient has not voided for more than 8 hour. abdomen is distended and restless latex allergy
apnea monitoring at home, what should you include in the teaching? ensure alarm can be heard, avoid co-sleeping with the newborn
ECT side effects short term memory loss
bipolar disorder alterations of speech flight of ideas
schizophrenia problem- solving skills alone in a room with the fire alarm
teaching to the parents of a newborn zinc oxide
clozapine weight gain
elective cardioversion for a-fib cardiac compression
IVP abnormal response itching
hypoglycemia s/s irritability? vomiting
assessment of which child first appendectomy- sudden relief of pain
4 month old infant- failure to thrive the mother smiles at the infant
newborn need for intervention temperature 97.2
LPN scope of practice preparation of post-op bed? collection of stool sample
CVA is preparing for d/c. the nurse should anticipate the following actions identify community resources contact with home health agency verify that arrangement have been made for supplies occupational therapy services
GI bleeding and NG tube instill 75 mL of 0.9% NaCl
uric acid based urinary calculi formation the foods to include in the diet oranges
prevent heat loss via conduction by what interventions pad a scale with paper prior to weighing infant
infectious gastroenteritis-requires intervention by nurse ensuring the child BRAT diet
history of aggressive behavior requires intervention to prevent escalation to the client's anger pacing around the chair in which his wife is sitting
DM type I- highest priority medication regimen
new prescription for TPN monitor blood glucose
ABGs paCO2 - 33
active pulmonary TB private room- negative pressure
triaging four clients unstable vital signs
codeine every 4 hours for a client who is being d/c from hospital. proper administration of codeine- a need for further teaching urinary frequency
client in crisis- in what sequence in order to assist the client to cope safety relationship development of an action plan coordinate with support plan and provide
daughter of Alzheimer's pt, I don't know why I bother to visit my mother anymore - therapeutic communication it seems like you feel your visits are a waste of time
diaphragm- need for further teaching removal right after sex
funding for an educational program identify
case manager for mental health clients arranging transportation
implanted permanent pacemaker I will be able to use BATHS AND SHOWERS
pulmonary embolism receiving heparin 1200 units/ hr and warfarin 5 mg, aPTT 98 sec and INR 1.8 hold heparin
implanted venous access device palpate skin to locate the body septum of the port
skeletal traction for fractured femur highest priority upper chest petechiae- sign of embolism
AV fistula in right arm, include in the plan of care auscultate extremity for bruit
parents of toddler which foods recommend? steamed carrots
s/s fluid overload dyspnea
hemoglobin 7.8, include in the plan of care for a child observe dyspnea on exertion
right modifiable radial mastectomy interventions presence of one or more surgical drains
cardiac tamponade pericardial friction rub
adverse affect of fluoxetine headache
CF receiving O2 therapy- O2 toxicity bradypnea? restlessness
client education about digoxin and furosemide how to measure pulse rate measure intake need to report muscle weakness importance of obtaining daily body weight
misoprostol and NSAIDs serum pregnancy test
pressure ulcer formation shift weight hourly
acute blood loss requires blood transfusion that could potentially save her life, refuses explore the reasons for refusal? honor the decision
transition phase of labor which of the following breathing techniques? pattern paced
client falls more frequently between 0530-0730 while performing a root cause analysis investigate environmental factors
celiac disease foods baked chicken and wild rice
magnesium levels and interventions 1.3-2.1 initiate continuous cardiac monitoring
clonidine adverse effect dry mouth
pneumonia s/s in elderly acute confusion
sickle cell anemia- vaso-occlusive intervention pain medication
PICC line prior to starting infusion x-ray
attend to four client first confused and attempting to get out of bed
COPD and SOB completion of incident report increasing O2
IM injection to an obese person ventrogluteal
DM and capillary blood testing appropriate wash the client's hands
tape test for pinworms perform the test 1 hour after child falls asleep
adverse reaction to propranolol heart rate 110
terminal illness thinking about going home to be with loved ones. appropriate intervention social services
medication availability has been an ongoing problem with pharmacy staff inform nurse manager
child of autism manage behavioral outburst by limiting external stimuli
turning right side pillow
potential medication interaction with food phenytoin who requests a milkshake
packed RBC to client- needs to make a correction D5W- clots form
effective breastfeeding indication 6-8 wet diapers
short-leg cast and non weight bearing three-point gait
explosion in a nearby chemical plant. make room for clients dehydration- 680 mL
combative and aggressive client move client close to the nurses station
cancer, client asks nurse to make decision tell me more about your understanding of the options
physical assessment- need for intervention uses penlight to assess for changes in contour
talking about a client in the hallway tell the nurses to stop the discussion
CVA- lower the risk of ICP quiet environment? HOB 45
cataracts local community center s/s cloudiness and blurred vision
status epileptics medication diazepam
extended time to take a break I need to talk to you about the unit policies
I am going home- following action clarify notify surgeon AMA document
renal failure and received hemodialysis sodium 148
shaky nervous DM I give OJ wait 15 min recheck BS provide cheese and crackers
narrow QRS irregularly at rate 170/min with no visible P waves supraventricular tachycardia
physiological changes with aging decreased lung expansion
skin cancer- further teaching is needed I should a sunscreen with a minimal of SPF 10
DKA in emergency room start insulin therapy
do I have cancer? the provider will be here to talk you later
democratic leadership style seeks input
herpes simplex virus- precautions contact
bipolar disorder- increasingly restless, profanities, priority intervention move client away to a quiet place
chronic illness- defense mechanism hobby to compensate
manic phase of bipolar disorder grandiose thoughts
cranial nerve II clear objects from clients walking area
effectiveness of pain medication for a child using visualization to decrease child discomfort blow the hurt away
hyperthyroidism s/s tremors
domestic violence incident- It sounds as though you are feeling responsible for the violence last night
nausea and vomiting for the past two days- lab results 1.052- urine specific gravity
incident reports- need for further teaching I will document that an incident report in the medical record
tracheostomy suctioning hyperoxygenate with 100% oxygen before suctioning
hemianopsia use scanning techniques
colostomy care skin barrier over the stoma and hold for 30 seconds
captopril for htn- AP obtain BP before or after medication administration
statements about omeprazole and metronidazole the omeprazole will minimize acid in the stomach, and metron will tx infection
right to confidentiality list of family members who can receive info
total hip arthroplasty raised toilet seat
PACU report to provider stridor
cardiomyopathy- hospice- need for further teaching hospital- care is different- no longer tx
enteral tube feeding for an infant with cerebral palsy- charge nurse to intervene stabilize the tube by taping to the cheek
medication error too frequently? no risk
refuses to ambulate after abd surgery ask the patient rate his pain
3 hr oral glucose tolerance test obtain blood sample every 30 minutes
head injury, agitated, confused attempting to pull out IV- appropriate intervention
Created by: awill3217