A nurse is caring for a client who is scheduled for a procedure. Which of the following actions should the nurse take during the time-out?
(Select All that Apply.)

Ask the client to read their identification bracelet.

Ask the client to point to the surgical site.

Use two acceptable client identifiers.

Verify that the surgical site has been marked.

Ask the client to state the surgery being performed.

Answer and Explanation

Correct Answer : C

A.   Asking the client to read their identification bracelet can be additional verification steps, but it is not standard practice for all institutions

B.   To point to the surgical site can be additional verification steps, but it is not standard practice for all institutions.
C.   Using two acceptable client identifiers, such as the client's name and date of birth, to confirm the patient's identity.
D.   It is important to verify that the surgical site has been marked, which is a critical step in preventing wrong-site surgery.
E.   Asking the client to state the surgery being performed is a good practice as it involves the patient in their care and serves as a final verification of the correct procedure.

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Correct Answer is ["0.8"]

Explanation

(desired dose / available dose) x available quantity.

For this scenario, it would be (100 mg / 250 mg) x 2 mL, which equals 0.8 mL.

Therefore, the nurse should administer 0.8 mL of hydrocortisone per dose to deliver the prescribed 100 mg dosage.

A. Use petroleum-based ointments to moisturize lips. B. Choose a wool blanket when using oxygen. C. Store oxygen tanks upright. D. Keep oxygen tanks 4 feet away from an elect E. Peak T Wave on EKG

Correct Answer is C

Explanation

A. Petroleum-based products should not be used in conjunction with oxygen therapy. They are flammable and can pose a fire hazard when used near oxygen. Instead, use water-based moisturizers to prevent dryness of the lips and skin.
B. Wool and other synthetic fabrics can generate static electricity, which is a fire hazard when using oxygen
therapy. It’s safer to use cotton blankets, as they are less likely to cause static buildup.
C. Oxygen tanks should be stored upright to prevent them from falling over and to ensure the regulator and valves are properly aligned. Storing tanks upright helps maintain stability and prevents accidental damage to the equipment.
D. While the recommendation to keep oxygen tanks away from electrical sources is important, the distance may vary based on specific guidelines. It is generally advised to keep oxygen tanks at least 5-10 feet away from electrical sources and heat sources to avoid any risk of ignition or fire.

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A nurse is caring for a client who is scheduled for a procedure. Which of the following actions should the nurse take during the time-out? (Select All that Apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is preparing to administer hydrocortisone 100 mg IM daily to a client. Available is hydrocortisone 250 mg/2 mL. How many mL should the nurse administer per dose? (Round the answer to the nearest tenth number. Use a leading zero if it applies. Do not use a trailing zero.)

Correct Answer is ["0.8"]

Explanation

A nurse is teaching a client who has a prescription for home oxygen therapy. Which of the following instructions should the nurse include?

Correct Answer is C

Explanation

A nurse is caring for a client who has nausea and is vomiting. The nurse should identify the client is at risk for which of the following acid-base imbalances?

Which of the following is an appropriate evaluation method to assess the effectiveness of home care teaching after a client has surgery?

Which of the following is a potential consequence of consuming alcohol prior to an outpatient surgical procedure involving anesthesia?

A nurse is caring for a client who has COPD. The nurse should identify the client is at risk for which of the following acid-base imbalances?

A nurse is assessing a client who has diarrhea. Which of the following findings is a manifestation of hypokalemia? (Select All that Apply.)

A nurse is preparing to administer vancomycin 15 mg/kg/day divided equally every 12 hr. The client weighs 198 lb. How many mg should the nurse administer with each dose? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

During the preoperative period, what is the nurse's responsibility regarding informed consent?

A nurse is assessing a client who has COPD. Which of the following findings should the nurse expect?

A nurse is caring for a client who is scheduled for a procedure. Which of the following actions should the nurse take during the time-out?
(Select All that Apply.)