UNIT 2 Flashcards
Differences in socioeconomic status , religious affiliation, educational level and spoken dialect can result in translation barrier ?
True or False
True
The nurse would intervene when message therapy has been prescribed for a client who is taking the medication warfarin?
True or False
True
A client receives a wrong medication. Which action would the nurse who made the medication error take first?
Assess the client
When receiving the admitting prescription for a client, the nurse notes the dose of the medication is three times the usual dose of this medication. Which of action would the nurse take ?
Contact provider to question the dosage
The client is recovering from a bowel resection surgery with no complications that occurred three days ago.the client is ambulating in the hallway and taking very little pain medication. The healthcare provider tells the client that a “lesion removed” during surgery is cancerous. Which factor will likely be the clients most significant obstacle to learning during discharge teaching?
Anxiety associated with the new diagnosis
An adult client is newly admitted to the post anesthesia care unit (PACU) from surgery. Which assessment finding would be the nurses priority?
The clients respirations are 6-8 per minute
A nurse in the rural health clinic is caring for a client who has heart failure. The client states “im not going to take anymore heart medicine” which response would the nurse make?
“Tell me more about your decision to stop your heart medication”
A nurse is assessing a newly admitted client. Which information would the nurse include in the cultural portion of the assessment ?
Food preference
A nurse in a long term care facility is transferring a client to an acute care facility. Which information would the nurse include in the transfer paperwork?
List of current medication
The registered nurse delegates the task of obtaining the blood pressure for a client who is two hours postoperative following and appendectomy, to a licensed practical nurse. The LPN reports a blood pressure that is significantly higher than the clients previous readings, which action with the register nurse take first?
Recheck the clients blood pressure
Surgeon prescribes, potassium chloride elixir 20 meq by mouth daily for a client with an NG tube connected to low intermittent suction. How will the nurse proceed?
A. See clarification from the surgeon about the medication error
B. Clamp the NG tube administering the dose by mouth.
C. And still the medication through the NG tube.
D. Withhold, oral potassium chloride Elixir
A. See clarification from the surgeon about the medication error
Despite less restrictive intervention, a clients behavior escalates require an emergency application for strength, which action will the nurse perform by the situation?
A.?
B. Evaluate the client status every four hours while restrained.
C. Release the restaurants in checks circulation every hour.
D. Continue to reevaluate the clients need for restraints. 
D. continually reevaluate the clients need for restraints
A client is brought to the emergency department after inhaling mercury which acute adverse effect associated with mercury inhalation would the nurse assess?
A. Chest pain, pneumonitis, and inflammation of the mouth.
B. Intestinal, obstruction and numbness of the hands.
C. Hypertension, oliguria, and tingling of the feet.
D. Tachycardia, hematuria, and diaphoresis.
A. Chest pain, pneumonitis, and inflammation of the mouth.
Which client with the nurse safely delegate morning care to the unlicensed assistive personnel?
A. The client admitted with a closed head injury.
B. The client admitted with septic shock.
C. The client who underwent surgical repair of bowel destruction two days ago.
D. The client admitted with an exacerbation of asthma with dyspnea on exertion.
C. The client who underwent surgical repair of a bowel obstruction two days ago.
The client with diarrhea is incontinent of liquid stool. The Nurse documents at the patient has excoriated skin on the Buttocks, which finding by the nurse led to this documentation?
A. Skin with soft and from prolonged exposure to moisture.
B. Superficial layers of skin were absent.
C. The epidermal layer of the skin was rubbed away.
D. The client admitted with an exacerbation of asthma with Dyspnea on exertion.
B. Superficial layers of skin were absent.
The client has just returned from post anesthesia care unit after undergoing an appendectomy and is complaining of severe incision pain. Which medication order listed on the medication administration record will offer the fastest relief?
A. Liquid acetaminophen with codeine
B. Intravenous, morphine sulfate.
C. Intramuscular meperidine
D. Oral oxycodone tablets.
B. Intravenous, morphine sulfate.
The client is administered furosemide 40 MG orally at 0900 the duration of action for this drug is approximately six hours after administration which time in military hours with the nurse no longer expect to see the effects of the drug?
A. 0930
B.1000
C.1100
D.1500
D.1500
The client suffered a myocardial infarction, three months ago during the hospitalization. The client had stents inserted into sites in the coronary arteries. The client was also prescribed a cholesterol lowering agent and two antihypertensive medication. What type of care is the client receiving???
A.Primary prevention
B. Secondary prevention
C. Tertiary prevention
D. Health promotion
C. Tertiary prevention
