A nurse is attending an interprofessional team conference for a client who experienced a stroke. For which of the following findings should the team request a prescription for a referral to the occupational therapist?

The client has four new medications.

The client has extreme difficulty swallowing.

The client is experiencing dysarthria.

The client requires assistance getting dressed.

Answer and Explanation

The Correct Answer is D

Choice A Reason:
The client has four new medications is incorrect. While the addition of new medications may require monitoring and adjustment, it does not directly indicate a need for occupational therapy. Medication management is typically addressed by the healthcare provider or pharmacist.
Choice B Reason:
The client has extreme difficulty swallowing is incorrect. This finding suggests dysphagia, which may require intervention from a speech-language pathologist rather than an occupational therapist. Speech-language pathologists specialize in assessing and treating swallowing difficulties.
Choice C Reason:
The client is experiencing dysarthria is incorrect. Dysarthria refers to difficulty in speaking due to weakness or poor coordination of the muscles used for speech. While it may affect communication and daily activities, it is primarily addressed through speech therapy rather than occupational therapy.
Choice D Reason:
The client requires assistance getting dressed is correct. Difficulty with activities of daily living, such as dressing, bathing, and grooming, is within the scope of occupational therapy. Occupational therapists help clients regain independence in activities of daily living through interventions aimed at improving fine motor skills, coordination, and adaptive strategies. Referring the client to an occupational therapist can help address their dressing needs and promote independence in self-care activities.

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Correct Answer is C

Explanation

Choice A Reason:
Medicating the client with alprazolam, should not be the first action as it involves administering medication that could mask underlying issues and may not be appropriate without further assessment.
Choice B Reason:
Reorienting the client to his surroundings, is important for addressing confusion, but it should not be the first action until the nurse has ruled out any immediate physiological concerns.
Choice C Reason:
When a client presents with confusion and agitation after returning from an acute care facility, it's important for the nurse to prioritize assessing the client's physiological status by measuring vital signs. Changes in vital signs could indicate underlying medical issues such as infection, dehydration, or other physiological disturbances that may be contributing to the client's symptoms.
Choice D Reason:
Offering reassurance to the family, is important for providing support, but it should not be the first action as it does not directly address the client's immediate needs related to confusion and agitation.

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

Correct Answer is D

Explanation

Choice A Reason:
Fidelity is inappropriate. Fidelity refers to the obligation to fulfill commitments and responsibilities. While important in maintaining trust and professional relationships, fidelity may not directly apply to the situation described.
Choice B Reason:
Nonmaleficence is inappropriate. Nonmaleficence is the principle of doing no harm. In this situation, ensuring the safety and well-being of the client is paramount, and failing to use a gait belt could potentially lead to harm. However, the primary issue in this scenario is the accuracy and completeness of the incident report rather than the act of causing harm.
Choice C Reason:
Beneficence is inappropriate. Beneficence is the principle of doing good and acting in the best interest of the client. While ensuring the use of a gait belt aligns with promoting the client's safety and well-being, the primary concern in this scenario is the integrity and honesty in reporting the incident accurately.
Choice D Reason:
Veracity is appropriate. Veracity refers to truthfulness and honesty. In this situation, the charge nurse should ensure that the incident report accurately reflects the circumstances of the fall, including the absence of the gait belt. Being truthful and transparent in reporting incidents is essential for maintaining trust, promoting accountability, and improving patient safety.

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A nurse is attending an interprofessional team conference for a client who experienced a stroke. For which of the following findings should the team request a prescription for a referral to the occupational therapist?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse in a long-term care facility is assessing a client who has returned from an acute care facility following a brief illness. The nurse observes that the client is confused and agitated. Which of the following actions should the nurse take first?

Correct Answer is C

Explanation

Correct Answer is D

Explanation

The primary nurse asks another nurse to assist in checking a client for an apical-radial pulse deficit. One nurse counts an apical pulse of 72 beats/minute while the other nurse counts a radial pulse of 88 beats/minute. Which action should the primary nurse take?

A charge nurse is observing a newly licensed nurse provide care to four clients. Which of the following actions requires intervention by the charge nurse?

A nurse is preparing to discharge a client from an acute care facility to home. Which of the following information should the nurse plan to include in the client's discharge documentation?

A nurse suggests respite care for the partner of a client who has mild cognitive impairment. The client's partner asks the nurse how that would help. The nurse should explain that respite care would do which of the following?

A nurse manager observes an assistive personnel (AP) incorrectly transferring a client to the bedside commode. Which of the following actions should the nurse take first?

A charge nurse witnesses an assistive personnel (AP) failing to follow facility protocol when discarding contaminated linens. Which of the following actions should the nurse take first?

A nurse is orienting a newly licensed nurse on the neurological unit. Which of the following clients should the nurse assign to the newly licensed nurse?

A nurse manager is reviewing isolation guidelines with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?