A nurse is planning to assess a group of four postoperative clients. Which of the following clients should the nurse assess first?
A client who received an antiemetic and still reports nausea
A client whose urine output has averaged 32 mL/hr for the past 24 hr
A client whose heart rate has increased, and blood pressure has dropped
A client who reports their pain level as 8 on a scale of 0 to 10
The Correct Answer is C
A. Persistent nausea is uncomfortable but not immediately life-threatening.
B. Urine output of 32 mL/hr is low but may not be an urgent emergency without other signs.
C. An increased heart rate with a drop in blood pressure indicates possible shock or bleeding and requires immediate assessment.
D. Severe pain requires timely intervention but is not as immediately critical as vital sign instability.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","E"]
Explanation
A. In a win-lose approach, one party (often the person in authority) dominates the decision-making, leading to a one-sided outcome.
B. This method disregards employee input, reflecting a top-down, authoritarian approach.
C. Win-lose methods often involve power struggles, as one side tries to assert control over the other.
D. This describes a win-winapproach, not win-lose. In win-lose, only one party benefits.
E. The lack of collaboration and openness in a win-lose approach can create a culture where staff feel undervalued or fearful of speaking up.
Correct Answer is D,C,E,A,B
Explanation
D. Identify the standard criteria for infection control. Begin by defining what the benchmarks or acceptable standards for infection control are (e.g., CDC guidelines).
C. Gather and analyze the collected data. Collect real-time data from the hospital on current infection rates and analyze trends.
E. Compare the established standards to the collected data. Assess where gaps exist between the actual performance and the desired standards.
A. Plan strategies to reduce the infection rate. Based on identified gaps, create interventions and improvement plans (e.g., hand hygiene training, protocol changes).
B. Evaluate to determine whether infection control rates have improved. After implementing changes, reassess data to see if infection rates have decreased, completing the QI cycle.
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