solution rated A+ 2023
The nurse calls the surgeon to report that a male client who has transitioned from a PCA to PO analgesic
one hour ago is now complaining in a loud voice and asking for the PCA pump. The nurse explains that
the client's behavior is disturbing his roommate. The client's BP has increased from 120/72 to 150/98.
Which question is best to include in the recommendation component of the SBAR report the the
surgeon?
A. Could the behavior be a manifestation of drug seeking?
B. Can the client be transferred to a private room?
C. Can the PCA be initiated and prescribed for an additional 12 hours? - correct answer A. Could the
behavior be a manifestation of drug seeking?
The nurse is assigned to care for four clients. After receiving the change of shift report, which client
should the nurse assess first?
A. A client with diabetes and a history of coronary artery disease who is complaining of increased SOB
B. A 10 year old with sickle cell disease who has a PCA pump and is complaining of pain2-3/10
C. A 29 year old who has had CKD for the past year and had an AV fistula placed yesterday
D. An older client with COPD who is experiencing SOB and who O2 sat is 88% on RA - correct answer A. A
client with diabetes and a history of coronary artery disease who is complaining of increased SOB
A HCP notifies the nurse that new prescriptions have been written for a client. Which is the first action
the nurse should implement?
A. Collect any needed form such as labs and radiology requisitions
B. Clarify the prescriptions with the unit clerk to ensure accurate transcrition
C. Document the time that the provider visited the client in the nurses' notes
, D. Read all of the new prescriptions for the client written by the provider - correct answer D. Read all of
the new prescriptions for the client written by the provider
A RN, PN and UAP are working as team to provide care for a acutely ill client requiring immediate
bedside insertion of a chest tube. Which assignment is the best use of each person's skills?
A. RN inserts chest tub immediately after PN cleans the skin at insertion site
B. The UAP listed to breath sounds while the RN witnesses the informed consent
C. The PN instructs the family about he need for chest tube insertion while the RN obtains VS
D. The UAP obtains an O2 sat level while the RN reports the findings to the HCP - correct answer D. The
UAP obtains an O2 sat level while the RN reports the findings to the HCP
An older woman with a long history of HTN is transferred from a long term care unit because of HF. She
has a signed and witnessed DNR in her record. What action should the nurse take?
A. Transfer client to palliative care unit for further supportive care
B. Consult with hospice case manager regarding plan of care
C. Confirm current resuscitation wishes with client and family
D. Ask the unit supervisor to meet with the family about desired care level - correct answer C. Confirm
current resuscitation wishes with client and family
When caring for an older adult with septic shock, which intervention is most important for the nurse to
include in this client's plan of care?
A. maintain strict I&O
B. assess warmth of extremities
C. Keep HOB elevated 45 degrees
D. Monitor blood glucose level - correct answer B. assess warmth of extremities
A client is admitted with exacerbation of COBD and reports that it is difficult to eat due to SOB. WHich
tasks should the nurse delegate to UAP? SATA