A nurse is planning care for a hospitalized client who is immobile and in a continuous mitten restraint. Which of the following interventions should be included in the client's care plan? (Select all that apply.)

Ensure two fingers can fit between the device and the client.

Perform a neurovascular check every 2 hours.

Secure the restraint to the bedrail.

Obtain a prescription renewal every 72 hours.

Implement passive range-of-motion exercises.

Answer and Explanation

Correct Answer : A,B,D,E

A. Ensuring two fingers can fit between the device and the client is crucial for monitoring circulation and preventing skin breakdown.
B. Performing a neurovascular check every 2 hours is necessary to assess circulation and nerve function, ensuring that the restraint is not causing harm.
C. Securing the restraint to the bedrail is not appropriate; restraints should be secured to the movable part of the bed frame to avoid causing injury.
D. Obtaining a prescription renewal every 72 hours is required for ongoing restraints, as it ensures continued monitoring and justification for their use.
E. Implementing passive range-of-motion exercises is essential to maintain joint mobility and prevent complications associated with immobility.

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Correct Answer is D

Explanation

A. While human error contributes to adverse events, the focus of selecting surveillance systems is on prevention through technology rather than just acknowledging errors.
B. Although data systems can provide documentation, the primary goal of surveillance systems is to monitor and prevent events rather than serve as a backup.
C. Illegibility in documentation can lead to errors, but this option does not specifically address the role of surveillance technology in preventing adverse events.
D. Physiologic monitoring systems are designed to detect early physiological changes, which can help prevent adverse events before they occur, aligning with the aim of using technology effectively.

A. Admission notes B. Orders C. Laboratory findings D. Patient profile E. Vital signs

Correct Answer is {"A":{"answers":"B"},"B":{"answers":"C"},"C":{"answers":"A"},"D":{"answers":"A"},"E":{"answers":"A"}}

Explanation

Admission notes: Knowledge
Admission notes provide insights into the patient's medical history and current condition, which requires understanding and context, indicating knowledge.
Orders: Wisdom
The orders reflect clinical judgment and decision-making based on the patient's condition and needs, indicating wisdom.
Laboratory findings: Data
Laboratory findings present measurable results (e.g., blood glucose, serum ketones, pH), representing raw data.
Patient profile: Data
The patient profile includes demographic information and medical history, which are factual data points.
Vital signs: Data
Vital signs are quantitative measurements that provide objective data on the patient's physiological status.

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A nurse is planning care for a hospitalized client who is immobile and in a continuous mitten restraint. Which of the following interventions should be included in the client's care plan? (Select all that apply.)

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Naxlex Comprehensive Predictor Exams

As the head nurse involved in selecting which patient surveillance systems to acquire for your unit, one of your aims is to avoid adverse events through the implementation of appropriate technology. This particular aim recognizes that:

Correct Answer is D

Explanation

Correct Answer is {"A":{"answers":"B"},"B":{"answers":"C"},"C":{"answers":"A"},"D":{"answers":"A"},"E":{"answers":"A"}}

Explanation

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A nurse is planning care for a hospitalized client who is immobile and in a continuous mitten restraint. Which of the following interventions should be included in the client's care plan? (Select all that apply.)