The nurse is caring for a client with an acute bleeding cerebral aneurysm. Which of the following activities is not appropriate in nursing care
A. Position the client to prevent airway obstruction.
B. Keep the client in one position to decrease bleeding.
C. Administer IV fluid as ordered and monitor the client for signs of fluid volume excess.
D. Maintain the client in a quiet environment.
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Which of the following would the nurse interpret as indicating that a child is receiving too much intravenous fluid too rapidly
A. Marked increase in abdominal girth.
B. Evidence of protein in the urine.
C. Dark amber colored urine.
D. Moist crackles in the lung fields.
Nursing care for a client after electroeonvulsive therapy (ECT) should include which of the following
A. Nothing by mouth for 24 hours after the treatment because of the anesthetic agent.
Bed rest for the first 8 hours after a treatment.
C. Assessment of short-term memory loss.
D. No special car
Which of the following should the nurse include in a postoperative teaching plan for a client with a laryngectomy
A. Telling the client to speak by covering the stoma with a sterile gauze pad.
B. Reassuring the client that normal eating will be possible after healing has occurred.
C. Instructing the client to avoid coughing until the sutures are removed.
D. Instructing the client to control oral secretions by swabbing them with tissues or by expectorating into an emesis basin.
A client undergoes a total laryngectomy and tracheostomy formation. On discharge, which instruction should the nurse give to the client and family
A. "Clean the tracheostomy tube with alcohol and water. "
B. "Family members should continue to talk to the client. "
C. "Oral intake of fluids should be limited for 1 week only. "
D. "Limit the amount of protein in the diet. "
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