The nurse is working on a long-term rehabilitation unit, is providing care for a 46-year-old woman who was the victim of a violent crime and suffered a head injury. The patient has an endotracheal tube, which is secured
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The nurse is working on a long-term rehabilitation unit, is providing care for a 46-year-old woman who was the victim of a violent crime and suffered a head injury. The patient has an endotracheal tube, which is secured with tape. The tape is crusted with dried secretions. The nurse is providing personal hygiene for the patient and needs to replace the tape. What is the best way for the nurse to remove the tape?
a. Soak it with warm moist washcloths.
b. Pull it gently away from the skin.
c. Saturate it with denatured alcohol.
d. Soak it with adhesive remover.
The student nurse caring for a 56-year-old patient with acquired immunodeficiency syndrome (AIDS). While providing oral care for the patient the student nurse notes that the gums are reddened and bleed easily. The student nurse identifies this as a sign of what condition?
a. Dental caries
b. Gingivitis
c. Oral herpes
d. Thrush
A 25-year-old patient was admitted to the surgical floor wearing contact lenses. Assistive personnel ask the nurse if contact lenses need special attention. The nurse informs the assistive personnel that non–extended-wear contacts left in the eyes for an extended period of time can cause which of the following?
a. Blindness
b. Corneal injury
c. Otitis externa
d. Otitis media
4. A 45-year-old woman with diabetes who has been hospitalized with diabetic ketoacidosis. Which of the following is most important for the nurse to assess during bath time?
a. Skin bruising
b. Condition of teeth
c. Sensation to the foot
d. Skin folds for dirt
A nursing student who is working on a postsurgical unit assisting patients with personal hygiene plans to provide a back rub to each of her patients. The nursing student discusses the importance of this activity because research demonstrates that it enhances patient comfort and relaxation with the nurse assigned to these patients. The nurse instructs her that back rubs would be contraindicated on which of the following patients?
a. A 56-year-old patient with a colon resection
b. A 45-year-old patient with a spinal cord injury
c. A 67-year-old patient with an appendectomy
d. A 24-year-old patient with an abdominal hysterectomy
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