The patient is admitted with osteoarthritis. After assessment, the nurse notes that the patient walks with a limp. What is the priority nursing diagnosis?
Impaired Physical Mobility
Activity intolerance
Ineffective Health Maintenence
Chronic Osteoarthritis
Which of the following would a nurse not consider before performing a bed bath on a patient?
Patient's level of orientation
Patient's Cognitive Ability
If there is an order for the bath
Muskuloskeletal function of the patient
You are ordered to comb the hair of a patient who has head lice. What personal protective equipment will you need to use? (Select all that apply)
Gown
Mask
Goggles
Gloves
Hair Cap
In many situations, a patient has sufficient strength to walk if he or she can do which of the following?
Lie Prone for 1 hour
Raise the foot off the bed 1 inch
Sit up in bed for 1 hour
Able to reach the call light
What is the best way to keep patient's safety while helping use bedpan? (Select all that apply)
Raise the side rail while rolling the patient to one side
Respond promptly to call light
Put Call-light and toilet paper within reach
Close door or curtain for patient's privacy
Raise head of the bed for comfort position
Which of the following is not a problem patient’s may experience when placed in the supine position?
Head Flat on the Mattress
Unsupported Feet
Hips externally rotated
Neck Hyperextension
Assessment of a patient's mobility can be done by focusing on...( Select all that apply)
Gait
Their ability to walk
ROM
Body Alignment
The neck is a pivotal joint and uses the sternocleidomastoid and trapezius muscles for movement. What are the ROM performed by the neck?
Supination, Pronation, Rotation, Hyperextension.
Flexion, Extension, Lateral Flexion, Hyperextension, Rotation.
Abduction, Adduction
Opposition, Abduction, Adduction, Lateral Flexion.
Assessing a patient’s gait allows for the nurse to draw conclusions about the patient’s balance, posture, and ability to walk without any assistance. What is one way to assess gait?
Observing the patient while they enter a room, noting speed and stride.
Asking the patient to perform jumping jacks.
Observing the patient tie their shoes.
Asking the patient to flex and extend their elbows.
A patient has been admitted due to a fall and has sustained a broken ankle. Which of the following positions poses the greatest risk for developing a pressure ulcer in the now immobile patient?
Side-Lying Position
Sim's Position
Supine Position
Supported Fowler's Position
When putting a baby to bed, the parents should not do the following. (Select all that Apply)
Place infant on back
Place infant on their belly
Place only one pillow in crib
Make sure pacifier is attached to string
Which of the following are basic human needs? (Select all that apply)
Oxygen
Nutrition
Happiness
Temperature
Which of the following should you do when a patient is experiencing a seizure? (Select all that apply)
Stay with the patient
Try to move the patient to a safer place
Turn the patient on their side with their head tilted forward
Protect their head by placing it on padding or in your lap
What should a nurse do to prevent a patient from falling that has postural hypertension? (Select all that apply)
Assess patient range of motion
Dangle patients feet on the side of the bed
Have patient stand up immediately
Have patient sit on the side of their bed
The hospital starts on fire what should a nurse to in this situation? (Select all that apply)
Run out of the hospital
Activate the alarm
Open all the doors
Extinguish the fire at the base of the flames
A patient in the hospital is having trouble sleeping at night. What should the nurse suggest to the patient? (Select all that apply)
Suggest the patient eat a large meal 1 hour before bed
Suggest the patient try drinking a glass of warm milk before bed
Tell the patient to exercise 30 minutes before bed
Tell the patient to close their door to avoid loud noises in the hallway
Tell the patient to avoid taking naps during the day so they can sleep better at night
Patient presents to the clinic complaining of fatigue, restlessness and feeling overall tired. The client states that she is a light sleeper and has trouble falling asleep. The patient has no past medical history and is cleared of any chronic illnesses. What stage is the patient describing as a period of light sleep?
Phase 1
Phase 5
Phase 3
Phase 4
Patient is awake multiple times a night to urinate and is unable to sleep wakes up the next morning irritated. What is the cause of this?
Insomnia
Nocturia
Resting State
Narcolepsy
All of the above
While interviewing a patient, the patient states they are having difficulty falling asleep at night. The patient reports waking up at least 2 to 3 times in the middle of the night and is not able to fall back asleep. What questions should the nurse ask to assess the patient? Select all that apply.
Do you sleep in a quiet environment?
Have you had any recent lifestyle changes?
What do you eat for breakfast in the morning?
Do you drink caffeine at night?
Nursing care plan for a client with sleep problems has been implemented. All of the following would be expected outcomes except:
Client is satisfied with amount of sleep
Client falls asleep within 1 hour of going to bed
Client reports no episodes of awakening during the night
Client rates sleep as an 8 or above on the visual analog scale
