Chest x-ray: Consolidation in the right lower lobe consistent with pneumonia Review H and P, nurse's notes, flow sheet, doctor's order, and Imaging studies.
What statements indicate the client's confusion is resolving?
Select all that apply.
Asks how long he has been in the hospital
Drinking broth
States he is hungry
Clawing at the air
Keeps trying to get out of bed to find the swimming pool
Recognizes his daughter
Oriented to time, place, and self
Oxygen saturation on 0.5L of 100%
Correct Answer : A,B,C,F,G
Based on the given information, the statements that indicate the client's confusion is resolving are:
- Asks how long he has been in the hospital: This shows cognitive awareness and the ability to ask relevant and coherent questions.
- States he is hungry: This indicates a return to normal appetite and the ability to recognize and express basic needs.
- Recognizes his daughter: This demonstrates the ability to recognize and identify a familiar individual, suggesting an improved level of cognitive functioning.
- Oriented to time, place, and self: Being aware of the current time, location, and personal identity reflects an improved level of orientation and mental clarity.
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The statement "Drinking broth" does reflect the client's willingness and ability to consume food.
The following statements suggest ongoing confusion or potential issues:
- Clawing at the air: This behavior may indicate restlessness, agitation, or disorientation.
- Keeps trying to get out of bed to find the swimming pool: This behavior may indicate confusion or an altered perception of reality.
The statement "Oxygen saturation on 0.5L of 100%" provides information about the client's oxygen saturation level but does not specifically address the resolution of confusion.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
The activity that the PN should suggest to meet the physical and social needs of wheelchair-bound older residents who are mentally alert is an outdoor game of balloon
volleyball. It promotes physical activity, coordination, and social interaction among the residents. It allows them to engage with each other, participate in a fun and inclusive game, and enjoy the outdoor environment. Balloon volleyball can be adapted to accommodate individuals with varying abilities and provide an enjoyable and stimulating experience for wheelchair-bound residents who are mentally alert.
A. A picnic in the park: While a picnic in the park can be enjoyable, it may pose challenges for wheelchair-bound individuals in terms of accessibility and maneuverability. It might limit their participation and engagement in the activity.
B. An outdoor concert: While an outdoor concert can be entertaining, it may not actively engage wheelchair-bound residents. They may be limited in their ability to fully participate and interact with others during the concert.
D. A tea party in the courtyard: While a tea party can be a pleasant social activity, it may not provide the desired physical engagement for wheelchair-bound residents. They may require activities that involve more movement and physical participation.
Correct Answer is ["A","D","E"]
Explanation
During a generalized tonic-clonic seizure, it is important for the practical nurse (PN) to prioritize the safety and well-being of the child. The correct actions to implement immediately are:
A. Observe the progression of the seizure: The PN should closely observe the seizure to gather important information that can be helpful for medical professionals in assessing the seizure's characteristics and duration.
D. Pad the side rails with pillows: Padding the side rails of the bed with pillows helps to prevent the child from injuring themselves by hitting the side rails during the seizure.
E. Loosen clothing around the neck: Loosening any tight clothing around the child's neck helps to ensure adequate breathing and prevent any constriction or discomfort during the seizure.
B. Hold the extremities close to the body: This action is not recommended during a seizure as it may increase the risk of injury to the child or the PN.
C. Insert a tongue blade between the teeth: It is not recommended to insert any object, including a tongue blade, between the teeth of a person experiencing a seizure. This can cause injury to the person's mouth or teeth and is no longer considered an appropriate intervention for seizures.

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