A female client who is scheduled to be discharged within several hours shows the practical nurse (PN) a knife on her tray and states that she could use it to cut herself. What intervention is most important for the PN to implement?

Include guidelines for coping in the discharge plan.

Call dietary and ask them to send plastic utensils.

Inform the family of the client's statement.

Inform the healthcare provider who discharged the client.

Answer and Explanation

The Correct Answer is D

A.   Including guidelines for coping in the discharge plan might be important but doesn’t address the immediate concern of the client having access to a potential means of self-harm.
B.   Calling dietary for plastic utensils might help remove the immediate risk of harm, but informing the healthcare provider takes priority.
C.   Informing the family is essential for support but doesn’t directly address the current risk.
D.   Informing the healthcare provider who discharged the client is crucial as they need to reassess the discharge plan in light of the client's current statement and remove the potential means of self-harm.

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Correct Answer is C

Explanation

A. Complete blood count: Primarily measures the number of blood cells and their types. It does not directly assess the effectiveness of warfarin.
B. Creatinine clearance: Evaluates kidney function and doesn't directly reflect the efficacy of warfarin.
C. Prothrombin time (PT): Measures the time taken for blood to clot, an essential indicator for monitoring anticoagulation therapy like warfarin.
D. Serum troponin levels: Assesses cardiac damage and is not indicative of warfarin's effectiveness in managing atrial fibrillation.

A. A Write an incident report about the bruises on the infant. B. B Review the labor and delivery record for birth trauma. C. C Record the size and location of the areas in the infant's chart. D. D Notify the pediatrician of a possible bleeding problem with the infant.

Correct Answer is C

Explanation

A. Write an incident report about the bruises on the infant. - These areas might not be bruises; hence, writing an incident report without accurate information could be premature.
B. Review the labor and delivery record for birth trauma. - While important, it might not directly relate to the observed bluish-black areas.
C. Record the size and location of the areas in the infant's chart. - Documenting the observations is essential for tracking changes and informing other healthcare providers.
D. Notify the pediatrician of a possible bleeding problem with the infant. - Without further assessment, assuming a bleeding problem might be premature and unnecessarily alarming.

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A female client who is scheduled to be discharged within several hours shows the practical nurse (PN) a knife on her tray and states that she could use it to cut herself. What intervention is most important for the PN to implement?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client who was recently diagnosed with atrial fibrillation is receiving warfarin. To see the drug's effectiveness, which laboratory finding should the practical (PN) review?

Correct Answer is C

Explanation

During a daily assessment in the nursery, the practical nurse (PN) notices three large bluishblack areas on the back and buttocks of an African-American infant. Which action should the PN take?

Correct Answer is C

Explanation

Before administering zolpidem at bedtime, which client assessment should the practical nurse (PN) complete?

The practical nurses (PN) notes that an unlicensed assistive personnel (UAP) is ambulating a male client who had a stroke and has right-sided weakness. The UAP is walking on the client's left side. Which action should the PN take?

A chronically depressed older male resident of a long-term care facility has become more reclusive and today refuses to leave his room. His family has away and are unable to visit as much as in the past. Which comment by the practical nurse (PN) is likely to be most helpful to this client?

The practical nurse (PN) is caring for a 3-month-old male infant two days after a pylorotomy and notices that the infant is restless, grimacing, and drawing his knees to his chest. What action should the PN implement?

A 2-day-old infant with hydrocephalus returns from surgery following placement of a ventriculoperitoneal shunt. Which nursing intervention(s) should the practical nurse (PN) implement during postoperative care? (Select all that apply.)

What factors are important in determining the level of hypoxemia that the child may have experienced during the submersion? Select all that apply.

The practical nurse (PN) is administering a saline enema to a client who was admitted because of a fever of unknown origin and is now constipated. Which techniques should the PN use? (Select all that apply.)

When a small fire breaks out in the kitchen of a long-term care facility, which task should be performed by the practical nurse (PN) rather than the unlicensed assistive personnel (UAP)?