A nurse is assisting with the transfer of a patient from a medical-surgical unit to an intensive care unit following a change in status.
What information should the nurse include in the transfer documentation? (Select all that apply.)
Scheduled times for dressing changes.
Primary health problem.
Admission vital signs from 1 week ago.
Current medication prescriptions.
Number of family members who have visited.
Correct Answer : B,D
Choice A rationale
Scheduled times for dressing changes are not typically included in transfer documentation. This information is usually part of the patient’s daily care plan and can be communicated to the receiving unit as needed.
Choice B rationale
The primary health problem is crucial information to include in the transfer documentation. It provides the receiving unit with a clear understanding of the patient’s main health issue and the reason for their transfer.
Choice C rationale
Admission vital signs from 1 week ago are not typically included in transfer documentation. The most recent vital signs are more relevant and provide a better indication of the patient’s current health status.
Choice D rationale
Current medication prescriptions are essential to include in the transfer documentation. This information ensures continuity of care and prevents medication errors.
Choice E rationale
The number of family members who have visited is not typically included in transfer documentation. This information is not directly related to the patient’s health status or care needs.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
While it’s true that there are other ways to express intimacy besides intercourse, this response may not address the patient’s specific concern about sexual function following an orchiectomy.
Choice B rationale
This response directly addresses the patient’s concern. The removal of a single testicle does not typically prevent a man from having an erection or enjoying sexual activity.
Choice C rationale
While focusing on recovery is important, this response may not be helpful to the patient. It does not address his concern about sexual function and may make him feel that his concerns are being dismissed.
Choice D rationale
This response may not be helpful to the patient. It does not address his concern about sexual function and may make him feel that his feelings are being minimized.
Correct Answer is D
Explanation
Choice A rationale
Closing one’s eyes during wound dressing may indicate avoidance or denial, which are not effective coping strategies. It’s important for patients to be aware of their condition and participate in their care to the extent possible.
Choice B rationale
Spending the day staring at the TV may indicate withdrawal or depression, which are not signs of effective coping. Engaging in activities, socializing, and participating in physical therapy or rehabilitation can help improve mood and promote recovery.
Choice C rationale
While it’s normal for patients to want to stay home until they feel better or until they have completed reconstructive surgery, this statement alone does not necessarily indicate effective coping. It’s important for patients to gradually resume normal activities and social interactions as their condition allows.
Choice D rationale
Expressing a desire to see the surgical site indicates acceptance and a willingness to participate in care, which are signs of effective coping. This shows that the patient is taking an active role in their recovery and is not avoiding or denying their condition.
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