A nurse is preparing a client for transfer to another unit. Which of the following findings should the nurse include in the transfer report? (Select all that apply.)
Observations about family relationships
Response to pain medication
Review of ongoing discharge plan
Recent physical changes
Comprehensive demographic information
Correct Answer : B,C,D
A. Observations about family relationships: Personal relationship details are not required unless relevant to care.
B. Response to pain medication: Pain management effectiveness is crucial for continuity of care.
C. Review of ongoing discharge plan: The receiving unit should be aware of discharge plans to provide appropriate care.
D. Recent physical changes: Any changes in condition must be reported for safe care continuation.
E. Comprehensive demographic information: Basic demographic details are in the medical record and do not need to be included in a verbal report.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Takes several steps on tiptoes. Typically develops around 24 months, not 15 months.
B. Walks without assistance using a wide stance. At 15 months, toddlers typically walk independently with a wide stance to improve balance.
C. Has an accentuated cervical curvature when standing. Not an expected motor milestone.
D. Stands with the feet turned slightly inward. Inward foot positioning can indicate a developmental delay or foot abnormality.
Correct Answer is C
Explanation
A. Pulse oximetry reading of 95%. COPD clients often have lower baseline oxygen levels (88-92%), making this reading unexpectedly high.
B. Decreased depth of respirations. COPD typically causes shallow and rapid breathing due to air trapping.
C. Flaring of the nostrils: Nostril flaring is a sign of increased respiratory effort, which is common in COPD exacerbations.
D. Respiratory rate of 16/min. → Normal range (12-20/min), not an expected finding during dyspnea.
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