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A nurse prepares to administer an injection of morphine (Duramorph) to a client who reports pain. Prior to administering, the nurse is called to another room to assist another client onto a bedpan. She asks a 2nd nurse to give the injection. Which of the following actions should the 2nd nurse take?
- A. Offer to assist the client needing the bedpan.
- B. Administer the injection prepared by the other nurse.
- C. Prepare another syringe & administer the injection.
- D. Tell the client needing the bedpan she will have to wait for her nurse.
Correct Answer: A
Rationale: The correct answer is A. The second nurse should offer to assist the client needing the bedpan. This is important for patient safety and continuity of care. By offering assistance, the second nurse ensures that the immediate needs of the client are met promptly. Administering the injection prepared by the other nurse (B) may lead to errors and violates the principle of accountability. Preparing another syringe and administering the injection (C) is unnecessary and could delay care for the client needing assistance. Telling the client needing the bedpan to wait (D) is not appropriate as it neglects the client's needs.
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A nurse is collecting data from an older adult client as part of a neurosensory examination. Which of the following findings should the nurse expect as changes associated w/aging? Select all.
- A. Slower light touch sensation
- B. Some vision & hearing decline
- C. Slower fine finger movement
- D. Some short-term memory decline
- E. Slower superficial pain sensation
Correct Answer: B, C, D
Rationale: The correct answer is B, C, D. Vision and hearing decline, slower fine finger movement, and some short-term memory decline are all changes associated with aging. Vision and hearing tend to decline due to changes in the eyes and ears. Fine finger movement slows down due to changes in muscle strength and coordination. Short-term memory may decline as a result of changes in the brain's ability to process information. Slower light touch sensation and slower superficial pain sensation are not typically associated with normal aging.
A nurse is instructing a postop client about the sequential compression device the provider has prescribed. Which of the following statements should indicate to the nurse that the client understands the teaching?
- A. This device will keep me from getting sores on my skin.
- B. This thing will keep the blood pumping through my leg.
- C. With this thing on, my leg muscles won't get weak.
- D. This device is going to keep my joints in good shape.
Correct Answer: B
Rationale: The correct answer is B: "This thing will keep the blood pumping through my leg." This statement shows understanding because sequential compression devices help prevent blood clots by promoting blood circulation in the legs. Option A is incorrect as the device does not prevent skin sores. Option C is incorrect as it doesn't specifically address blood circulation. Option D is incorrect as the device does not impact joint health.
A goal for a client who has difficulty w/self-feeding due to rheumatoid arthritis is to use adaptive devices. The nurse caring for the client should initiate a referral w/which of the following members of the interprofessional care team?
- A. Social worker
- B. Certified nursing assistant
- C. Registered dietitian
- D. Occupational therapist
Correct Answer: D
Rationale: The correct answer is D: Occupational therapist. Occupational therapists specialize in helping individuals with physical limitations to maximize their ability to perform daily activities, such as self-feeding. They can assess the client's specific needs, recommend appropriate adaptive devices, and provide training on how to use them effectively. Social workers (A) focus more on psychosocial support, certified nursing assistants (B) provide direct care but may not have the expertise in adaptive devices, and registered dietitians (C) focus on nutrition-related issues. Therefore, the occupational therapist (D) is the most appropriate member of the interprofessional care team to address the client's self-feeding difficulties due to rheumatoid arthritis.
A nurse is preparing a presentation about basic nutrients for a group of high school athletes. She should explain that which of the following is the body's priority energy reserve?
- A. Fat
- B. Protein
- C. Glycogen
- D. Carbohydrates
Correct Answer: D
Rationale: The correct answer is D: Carbohydrates. Carbohydrates are the body's priority energy reserve because they are the primary source of energy for the body, especially during high-intensity activities like sports. When consumed, carbohydrates are broken down into glucose, which is used for immediate energy or stored as glycogen in muscles and the liver for later use. Fat is a long-term energy reserve but is not as readily accessible as carbohydrates for quick energy. Protein is primarily used for building and repairing tissues, not as a main energy source. Glycogen is a stored form of carbohydrates in the body, not the primary energy reserve.
A nurse is teaching a young adult client about health promotion & illness prevention. Which of the following statements by the client indicates an understanding of the teaching?
- A. I already had my immunizations as a child, so I'm protected in that area.'
- B. It is important to schedule routine health care visits even if I'm feeling well.'
- C. If I'm having any discomfort, I'll just go to an urgent care center.'
- D. If I am feeling stressed, I will remind myself that this is something I should expect.'
Correct Answer: B
Rationale: The correct answer is B: It is important to schedule routine health care visits even if I'm feeling well. This statement indicates an understanding of health promotion and illness prevention as it emphasizes the significance of preventive care to maintain overall health. Regular check-ups can help detect potential issues early on.
Incorrect choices:
A: I already had my immunizations as a child, so I'm protected in that area.
- This statement shows a misunderstanding of the need for ongoing preventive measures beyond childhood immunizations.
C: If I'm having any discomfort, I'll just go to an urgent care center.
- This statement reflects a reactive approach rather than a proactive one towards health.
D: If I am feeling stressed, I will remind myself that this is something I should expect.
- This statement does not address health promotion or illness prevention strategies.