A nurse is collecting data from a client who has an acute condition. Which of the following findings should the nurse identify as increasing the risk for potential client injuries?

Hearing acuity intact

Oriented to person only

Full range of motion bilateral lower extremities

Ability to use call light

Answer and Explanation

The Correct Answer is B

A)   Hearing acuity intact - Intact hearing acuity does not directly increase the risk for potential client injuries.
B)   Oriented to person only - Being oriented to person only may indicate confusion or disorientation, which can increase the risk for potential client injuries due to impaired decision-making or awareness of surroundings.
C)   Full range of motion bilateral lower extremities - Having a full range of motion in the lower extremities does not directly increase the risk for potential client injuries.
D)   Ability to use call light - The ability to use a call light indicates the client's ability to seek assistance, which reduces the risk for potential client injuries.

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Correct Answer is D

Explanation

A. Return the medication to the medication cabinet- Returning the medication without addressing the client's concerns does not promote understanding or collaboration.
B. Notify the provider of the client's refusal- Notifying the provider is important but should come after attempting to address the client's concerns.
C. Document the refusal in the client's medical record- Documentation is necessary but should follow a discussion with the client.
D. Inform the client of the potential consequences of their refusal- The nurse should first educate the client about the risks associated with not taking their antihypertensive medication to ensure they are making an informed decision.

A. Determine if the client has a support system. B. Schedule a mental health consult for the client. C. Provide the client with information about coping strategies. D. Encourage the client to attend a support group.

Correct Answer is A

Explanation

A) Determine if the client has a support system. - Assessing the client's current support network is essential to determine available resources and potential interventions.
B) Schedule a mental health consult for the client. - While mental health support may be necessary, understanding the client's existing support system is the first step.
C) Provide the client with information about coping strategies. - Providing coping strategies is important but should come after assessing the client's support system.

D) Encourage the client to attend a support group. - Encouraging attendance at support groups can be helpful, but it's important to assess the client's current support system first.

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A nurse is collecting data from a client who has an acute condition. Which of the following findings should the nurse identify as increasing the risk for potential client injuries?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who refuses their morning dose of antihypertensive medication. The client tells the nurse, "I'm not going to take this medication because it makes me sick and dizzy." Which of the following actions should the nurse take first?

Correct Answer is D

Explanation

A nurse is assisting with the care of a client who has a recent diagnosis of a chronic condition and is exhibiting findings of ineffective coping. Which of the following actions should the nurse take first?

Correct Answer is A

Explanation

A nurse on a medical-surgical unit receives a telephone call from an individual who identifies himself as the client's employer. The employer asks the nurse about the client's condition. Which of the following is an appropriate response by the nurse?

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A nurse is reinforcing teaching with a client about how to collect a stool specimen. Which of the following instructions should the nurse include?

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