A nurse is assigned to care for four clients. Which client should the nurse assess first?

A postoperative client preparing for discharge with a new medication.

A client requiring daily dressing changes of a recent surgical incision.

A client scheduled for a chest x-ray after insertion of a nasogastric tube.

A client with asthma who requested a nebulizer treatment during the previous shift.

Answer and Explanation

The Correct Answer is D

Choice A reason: While it is important to prepare the postoperative client for discharge and ensure they understand how to take their new medication, this situation is less urgent than addressing a potential respiratory issue.

Choice B reason: Changing the dressing on a recent surgical incision is part of routine care and can be scheduled after more urgent needs are addressed. The client’s wound care is important, but it does not take precedence over potential respiratory distress.

Choice C reason: Although the chest x-ray is necessary to confirm the correct placement of the nasogastric tube, this can be done after the more immediate concern of a respiratory issue is addressed. The nasogastric tube will remain in place for feeding or drainage in the meantime.

Choice D reason: This client should be assessed first because asthma can lead to respiratory distress or an asthma attack, which requires prompt intervention. Since the client requested a nebulizer treatment during the previous shift, it is crucial to assess their current respiratory status and administer the treatment if necessary to prevent any complications.

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Correct Answer is C

Explanation

Choice A reason: Providing nasopharyngeal suctioning for a client with pneumonia is within the scope of practice for an LPN. This task involves performing a procedure to clear the airway, which is a common responsibility for LPNs.

Choice B reason: Assisting a client who is 24 hours post-operative to use an incentive spirometer is appropriate for an LPN. This task involves helping a client with breathing exercises to prevent post-operative complications, which is a standard part of post-operative care.

Choice C reason: Teaching a new client who has asthma to use a metered-dose inhaler requires educational and assessment skills that typically fall within the scope of practice for a registered nurse (RN). While LPNs can reinforce education, the initial teaching and assessment of a client's understanding should be done by an RN.

Choice D reason: Collecting a clean catch urine from an ambulatory client with a wound is within the scope of practice for an LPN. This task involves obtaining a urine sample, which is a routine procedure that LPNs are trained to perform.

A. Fidelity B. Nonmaleficence C. Veracity D. Utilitarianism

Correct Answer is B

Explanation

Choice A reason: Fidelity refers to the ethical principle of keeping promises and maintaining trust. In nursing, this principle involves being loyal to the client and upholding commitments made to them. While important, fidelity does not directly address the nurse's concern about the potential harm caused by administering the opioid medication.

Choice B reason: Nonmaleficence is the ethical principle of "do no harm." This principle is directly applicable in this scenario, as the nurse's concern is about potentially hastening the client's death by administering the opioid medication. By choosing not to administer the medication, the nurse is acting to avoid causing harm, aligning with the principle of nonmaleficence.

Choice C reason: Veracity is the principle of truthfulness and honesty. It involves providing accurate information to clients and being truthful in communication. Although important in healthcare, veracity does not specifically address the nurse's concern about the potential harm of administering the opioid medication.

Choice D reason: Utilitarianism is an ethical theory that focuses on the consequences of actions and aims to achieve the greatest good for the greatest number of people. While utilitarianism can guide decision-making in healthcare, it is not the most relevant principle in this scenario where the primary concern is avoiding harm to the individual client.

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A nurse is assigned to care for four clients. Which client should the nurse assess first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

An experienced charge nurse is providing mentoring to a new charge nurse. The new charge nurse is making the shift assignment for a licensed practical nurse (LPN). Which assignment requires intervention by the experienced nurse?

Correct Answer is C

Explanation

Correct Answer is B

Explanation

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