A charge nurse in a long-term care facility is preparing an educational program about delirium for newly hired nurses. Which of the following statements should the nurse plan to include?

"Delirium has an abrupt onset."

"Delirium does not affect a client's sleep cycle."

"Delirium has a slow progression."

"Delirium does not affect a client's perception of her environment."

Answer and Explanation

The Correct Answer is A

Choice A reason:
Delirium is a sudden and acute change in mental status characterized by confusion, disorientation, altered consciousness, and other cognitive disturbances. It has an abrupt onset and is often related to an underlying medical condition, medication, or other factors such as infections or metabolic imbalances.
Choice B reason:
Delirium can indeed affect a client's sleep cycle. It often disrupts sleep patterns and can lead to sleep disturbances
Choice C reason:
Delirium does not have a slow progression. It is typically characterized by a rapid and fluctuating course, and it can develop over hours to days.
Choice D reason:
Delirium does affect a client's perception of their environment. Clients with delirium may experience hallucinations, paranoia, and other alterations in perception. They may be unable to accurately interpret or interact with their surroundings.

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Correct Answer is C

Explanation

Choice A reason:
Placing the wasted portion of the controlled substance in the sharp container is not correct. Wasted controlled substances should be disposed of according to specific regulations and facility protocols.
Choice B reason:
Asking a second nurse to record her signature when wasting an unused portion of the controlled substance is not a standard practice. The process for wasting controlled substances usually involves following specific documentation procedures, but this does not necessarily require a second nurse's signature.
Choice C reason:
Verifying the count total of the controlled substance after removing the amount needed is the appropriate action. When administering a controlled substance, it is crucial to maintain accurate accountability of the medication. This includes verifying the count total of the controlled substance before and after removing the amount needed for administration. This step helps ensure proper documentation, prevent errors, and maintain appropriate control over controlled substances.
Choice D reason:
Reporting any discrepancy in the count total of the controlled substance after administration is important, but it should be done as a separate step from verifying the count total before administration. Discrepancies should be reported according to facility policy to ensure proper investigation and resolution.

A. Notify the provider. B. Describe the surgery to the client. C. Provide brochures about the procedure. D. Complete an incident report.

Correct Answer is A

Explanation

Choice A reason:
The client has expressed a lack of understanding about the procedure, which indicates that they may not have received sufficient information or clarification. It is important to notify the provider so they can ensure the client fully understands the procedure before giving informed consent.
Choice B reason:
The nurse should provide basic information and answer questions within their scope, but detailed explanations about the procedure are best provided by the provider who is performing the surgery.
Choice C reason:
While brochures can be helpful, they do not replace the need for direct, clear communication with the healthcare provider about the specific details of the surgery.
Choice D reason:
An incident report is not necessary in this context as the situation is related to informed consent and not an error or safety issue.

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A charge nurse in a long-term care facility is preparing an educational program about delirium for newly hired nurses. Which of the following statements should the nurse plan to include?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is preparing to administer a controlled substance to a client for pain management. Which of the following actions should the nurse take?

Correct Answer is C

Explanation

A nurse is caring for a client who is scheduled for surgery. While the nurse is witnessing the client's signature, the client states, "I trust my doctor, but I don't understand what is meant by resecting my intestines." Which of the following actions should the nurse take?

Correct Answer is A

Explanation

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