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The nurse is teaching a client about a newly prescribed medication. To confirm that the client is learning the critical information, which strategy is most important for the nurse to include during the instruction?
- A. Provide client-focused information.
- B. Observe the client’s body language.
- C. Ask the client for learning feedback.
- D. Reinforce key points with the client.
Correct Answer: C
Rationale: Feedback confirms understanding.
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The nurse is viewing the admission assessment of a client with chronic pain. What intervention(s) should the nurse include in the client’s plan of care? Select all that apply.
- A. Encourage increased fluid intake and measure urinary output every 8 hours.
- B. Provide comfort measures such as topical warm application and tactile massage.
- C. Determine client’s objective measure of pain using a numerical pain scale.
- D. Assist the client to ambulate as much as possible during waking hours.
- E. Implement a 24-hour schedule of routine administration of prescribed analgesics.
Correct Answer: B,C,E
Rationale: Comfort, assessment, and analgesics manage pain.
A 64-year-old female client with a 3-day history of cough and chest pain is admitted for presumed pneumonia. The client has a history of type 2 diabetes mellitus and takes insulin glargine 17 units in the morning and 17 units in the evening. Which of the following actions should the nurse take to prevent medication errors?
- A. Double check all dosage calculations.
- B. nusually large or small doses.
- C. Compare the medication label to the order.
- D. Use at least 2 client identifiers before administering a dose.
- E. Involve and educate clients in medication administration.
- F. Document all medication in the electronic record as soon as it is given.
Correct Answer: A,C,D,E.F
Rationale: Verification and documentation ensure safety.
The client had a large, loose stool.
Vital signs: Temperature 98.7°F (37°C) orally. Heart rate 73 beats/minute.
Blood pressure 144/82 mm Hg. The client had a large, loose stool. The client had a large, loose stool.
Place the client on contact precautions.
Complete the diagram by dragging from the choices area to specify which condition the client is most likely experiencing, two actions the nurse should take, and two parameters to assess the client’s progress.
- A. Collect stool for culture, Start a high-fiber diet., Administer an oral steroid.,Make the client NPO
- B. Secretory diarrhea.Steatorrhea,Motility diarrhea,Osmotic diarrhea
- C. Heart rate, Serum potassium,Respiratory rate, Urine sodium
Correct Answer:
Rationale: Secretory diarrhea fits; stool culture and NPO address infection; heart rate and potassium monitor dehydration.
The primary nurse went on break at 1845. The covering nurse gave a second dose of insulin because of being unaware the primary nurse gave the ordered dose. Which error prevention techniques would have helped to avoid this?
- A. Double check all dosage calculations.
- B. nusually large or small doses.
- C. Compare the medication label to the order.
- D. Use at least 2 client identifiers before administering a dose.
- E. Involve and educate clients in medication administration.
- F. Document all medication in the electronic record as soon as it is given.
Correct Answer: A,C,D,E.F
Rationale: Documentation and verification prevent errors.
An older adult female client tells the clinic nurse about frequently awakening during the night and not being able to go back to sleep. What action(s) should the nurse suggest to the client to help improve sleep?
- A. Ask the healthcare provider for a mild sedative for bedtime.
- B. Take an afternoon nap to make up for missed sleep.
- C. Drink a mixture of warm water, whiskey, and honey at bedtime.
- D. Establish a regular time for going to bed and getting up.
- E. Avoid drinking caffeinated beverages late in the day.
Correct Answer: D,E
Rationale: Regular schedule and avoiding caffeine improve sleep.