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A 32 weeks patient is admitted to the maternity unit with severe preeclampsia. While her vital signs are being checked by the nurse she goes into convulsion, Which nursing action would be contraindicated in caring for the patient during an episode of convulsive eclampsia?
a. Not leaving the client
b. Keeping air passages clear of secretions
c. Firmly restraining the client to prevent injury
d. Having side rails up and padded
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- A patient tells the nurse she is having pain in her rightlower leg. How does the nurse assess for the presence ofthrombophlebitis?a. By palpating the skin over the tibia and fibulab. By documenting daily calf circumference measurementsc. By recording vital signs obtained four times a dayd. By noting difficulty with ambulationThe nurse is caring for a patient a toddler in the pediatric unit who is about to receive stitches for an abrasion to his upper arm. They both are concerned about the procedure being painful. What can the nurse tell both the parent and child that will alleviate the fears of pain? A. We will ask the parents to leave the room so the child will quiet down. B. We will apply topical lidocaine on the affected area prior to procedure, so he will not any pain during the procedure. C. We will administer inhaled gases for anesthesia, prior to procedure, so he will not any pain during the procedure. D. Ask the parents to stay the room and hold the child’s hand so the child will quiet down. 2. The nurse is reviewing types of anesthesia with newly student nurses during their clinical rotation. The students are correct when they state which type(s) of anesthesia is/are administered using lidocaine? (Select all that apply.) Which ones are included in balanced anesthesia? Select all that apply.…Imagine you are the nurse on duty for 3am to 11pm shift, a relative called your attention on room 169 that was admitted due to a suspected hazing incident. As you approach the patient you notice that the urine bag is empty since an hour ago. You immediately went to the room and find your patient lying on bed that is difficult to awaken. What will you do?
- A nurse is preparing a patient for a cesarean section and teachesher the effects of the regional anesthesia she will be receiving.Which effects would the nurse expect? Select all that apply.a. Loss of consciousnessb. Relaxation of skeletal musclesc. Reduction or loss of reflex actiond. Localized loss of sensatione. Prolonged pain relief after other anesthesia wears offf. Infiltrates the underlying tissues in an operative areaA nurse is developing a plan of care related to preventionof pressure ulcers for residents in a long-term care facility.Which action would be a priority in preventing a patient fromdeveloping a pressure ulcer?a. Keeping the head of the bed elevated as often as possibleb. Massaging over bony prominencesc. Repositioning bed-bound patients every 4 hoursd. Using a mild cleansing agent when cleansing the skinA nurse is assessing the vital signs of patients who presentedat the emergency department. Based on the knowledge ofage-related variations in normal vital signs, which patientswould the nurse document as having a normal vital sign?Select all that apply.a. A 4-month old infant whose temperature is 38.1°C(100.5°F)b. A 3-year old whose blood pressure is 118/80c. A 9-year old whose temperature is 39°C (102.2°F)d. An adolescent whose pulse rate is 70 bpme. An adult whose respiratory rate is 20 bpmf. A 72-year old whose pulse rate is 42 bpm
