NS 660 Exam 1 Review (100% Verified)

A nurse administers an antihypertensive medication to a patient at the scheduled time of 0900. The nursing assistive personnel (NAP) then reports to the nurse that the patient's blood pressure was low when it was taken at 0830. The NAP states they were busy and did not have a chance to tell the nurse yet. The patient begins to complain of feeling dizzy and light-headed. The blood pressure is rechecked and it has dropped even lower. In which phase of the nursing process did the nurse first make an error? Diagnosis Evaluation Implementation Assessment correct answers Assessment A charge nurse is observing a newly licensed nurse care for a client who reports pain. The nurse checked the client's MAR and noted the last dose of pain medication was 6 hr ago. The prescription reads every 4 hr PRN for pain. The nurse administered the medication and checked with the client 40 min later, when the client reported improvement. The newly licensed nurse left out which of the following steps of the nursing process? Intervention Evaluation Planning Assessment correct answers Assessment A nursing assessment for a patient with a spinal cord injury leads to several pertinent nursing diagnoses. Which nursing diagnosis is the highest priority for this patient? Risk for impaired skin integrity Risk for infection Spiritual distress Reflex urinary incontinence correct answers Reflex urinary incontinence While completing an admission database, the nurse is interviewing a patient who states "I am allergic to latex." Which action will the nurse take first? Immediately place patient in isolation