Nokea
The nurse is walking through a crowded waiting room when the respiratory therapist approaches the nurse and asks, 'How is the client in room 312?' Which of the following responses would be most appropriate for the nurse to make?
- A. I will document my most recent assessment in the client's medical record for your review.
- B. Additional medications were prescribed to help improve the client's respiratory status.
- C. The client was doing much better when I last checked during hourly rounds.
- D. We need to move away from this area to discuss the client's status.
Correct Answer: D
Rationale: Discussing client information in a crowded area risks breaching confidentiality. Moving to a private area ensures compliance with HIPAA and protects client privacy.
You may also like to solve these questions
The mother of a 4-month-old infant calls the physician's office reporting that her child has a temperature of 101°F and a rash that is blanchable and doesn't itch. What does the LPN expect will be ordered for this child?
- A. Aspirin
- B. Ibuprofen
- C. Acetaminophen
- D. Antibiotics
Correct Answer: C
Rationale: Acetaminophen is safe for fever in infants, addressing the temperature while the non-itchy, blanchable rash is monitored, likely viral.
A client's admission urinalysis shows the specific gravity value of 1.039. Which of the following assessment data would the nurse expect to find when assessing this client?
- A. Moist mucous membranes
- B. Urinary frequency
- C. Poor skin turgor
- D. Increased blood pressure
Correct Answer: C
Rationale: Poor skin turgor. The specific gravity value is high, indicating dehydration. Poor skin turgor (tenting of the skin) is consistent with this problem.
A client hospitalized with mania is racing wildly about the unit trying to organize the other clients into a game of Ping-Pong. The nurse should:
- A. Send the client to the recreation room for art therapy.
- B. Take the client outside for a walk.
- C. Allow the client to continue because his activities are goal directed.
- D. Suggest that the client do exercises to a video instead.
Correct Answer: B
Rationale: Taking the client for a walk redirects energy safely and reduces stimulation. Art therapy may not engage, continuing the activity risks escalation, and video exercises lack supervision.
A client undergoes cryosurgery for the removal of a basal cell carcinoma on the ear. Which of the following best describes the appearance of the area a few days after surgery?
- A. It's dry, crusty, and itchy.
- B. It's oozing and painful.
- C. It's dry and tender.
- D. It's swollen, tender, and blistered.
Correct Answer: A
Rationale: Post-cryosurgery, the treated area typically forms a dry, crusty scab and may be itchy as it heals.
The client is admitted with hypokalemia. An IV of normal saline is infusing at $80 \mathrm{ml} /$ hour with 10 meq of $\mathrm{KCl} /$ hour. Prior to beginning the infusion, the nurse should:
- A. Check the sodium level.
- B. Check the magnesium level.
- C. Check the creatinine level.
- D. Check the calcium level.
Correct Answer: B
Rationale: Hypokalemia is often associated with hypomagnesemia, which can impair potassium correction. Checking the magnesium level ensures effective treatment. Sodium , creatinine , and calcium levels are less directly related to potassium infusion safety.