A client receives an oral pain medication. In 1 hour the nurse should:

Complete a report

Call the client's provider

Reassess the client

Notify the nurse manager

Answer and Explanation

The Correct Answer is C

A reason:

Completing a report is not the priority action after administering pain medication. Reassessing the client's pain level and effectiveness of the medication is more crucial at this point.

B reason:

Calling the client's provider may be necessary if there are issues or if the pain is not managed, but the first step should be reassessing the client to determine the need for further action.

C reason:

Reassessing the client is correct. This helps determine the effectiveness of the pain medication and the need for additional interventions. It is important to monitor and document the client's response to the medication.

D reason:

Notifying the nurse manager is not the first action needed. The nurse manager can be informed if there are significant issues, but reassessing the client comes first to understand the medication's impact.

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Correct Answer is A

Explanation

A reason:

Instructing the client to tighten muscle groups for a short period and then relax is correct. Isometric exercises involve the contraction of specific muscles without moving the surrounding joints. This helps to maintain muscle strength and tone in clients on bedrest.

B reason:

Moving the client's limbs through their complete range of motion is more related to passive range of motion exercises, not isometric exercises. While important, this action does not align with the isometric exercise regimen prescribed in the plan of care.

C reason:

Asking the client to move her arms and legs while applying slight resistance involves isotonic or resistance exercises, which are different from isometric exercises. Isometric exercises focus on muscle contraction without joint movement.

D reason:

Having the client move each limb independently through its complete range of motion aligns with range of motion exercises, not isometric exercises. Isometric exercises specifically focus on muscle contraction without movement.

A. Evaluation B. Planning C. Assessment D. Implementation

Correct Answer is C

Explanation

A reason:

The evaluation phase involves assessing the effectiveness of the interventions and care plan, rather than gathering initial information about potential allergies. Asking about allergies comes earlier in the process.

B reason:

The planning phase focuses on setting goals and determining interventions based on the assessment data. While allergies are considered during planning, the initial gathering of allergy information occurs earlier.

C reason:

The assessment phase is correct. This is when the nurse collects comprehensive data about the client’s health status, including potential allergies. Gathering this information during assessment helps to prevent adverse reactions and plan safe care.

D reason:

The implementation phase involves carrying out the interventions outlined in the care plan. By this stage, any allergies should already be identified and documented to ensure safe execution of the care plan.

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A client receives an oral pain medication. In 1 hour the nurse should:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is prescribed bedrest. The plan of care indicates that the client should perform isometric exercises every 2 hours. Which of the following actions should the nurse take as directed by the plan of care?

Correct Answer is A

Explanation

A nurse in a clinic is interviewing a client who will undergo diagnostic testing. The nurse should ask about a client's potential allergies during which phase of the nursing process?

Correct Answer is C

Explanation

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