A nurse is preparing to apply a bed alarm for a client who is at risk for falls and attempts to get out of bed without assistance. After explaining the procedure to the client, which of the following actions should the nurse take next?

Instruct the client to use the call light for assistance.

Document the type of alarm used.

Test the alarm and battery of the device.

Apply the sensor pad to the client's bed.

Answer and Explanation

The Correct Answer is C

A. Instruct the client to use the call light for assistance. This is important but should be done after ensuring the alarm is working correctly.
B. Document the type of alarm used. Documentation is necessary but should follow ensuring the device is functioning.
C. Test the alarm and battery of the device. Ensuring the bed alarm and battery are functioning properly is critical to the safety of the client. The alarm needs to be reliable to alert staff if the client attempts to get out of bed.
D. Apply the sensor pad to the client's bed. This step is necessary but should follow testing the alarm and battery to ensure they are functioning.

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Correct Answer is D

Explanation

A. Elevated blood pressure This is not a common manifestation of a UTI in older adults.
B. Decreased heart rate This is not associated with UTIs.
C. Report of epigastric pain Epigastric pain is more related to gastrointestinal issues.
D. Mental confusion Older adults with UTIs often present with mental confusion or altered mental status, rather than the classic symptoms seen in younger individuals.

A. Flush the port with heparin prior to administering the medication. B. Inject the medication into the port closest to the client. C. Pinch the tubing below the injection port prior to administration. D. Administer the medication over 10 seconds.

Correct Answer is B

Explanation

A. Flush the port with heparin prior to administering the medication. Heparin is not typically used to flush the port before administering IV medications; saline is generally used for flushing.
B. Inject the medication into the port closest to the client. This ensures the medication is delivered quickly and effectively, minimizing dilution and maximizing its effect.
C. Pinch the tubing below the injection port prior to administration. Pinching the tubing can help ensure the medication goes into the client quickly but should be done only if specified by protocol.
D. Administer the medication over 10 seconds. Fentanyl should be administered slowly over 1-2 minutes to prevent rapid administration-related side effects like hypotension or respiratory depression.

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A nurse is preparing to apply a bed alarm for a client who is at risk for falls and attempts to get out of bed without assistance. After explaining the procedure to the client, which of the following actions should the nurse take next?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A charge nurse is teaching a group of newly licensed nurses about manifestations of urinary tract infections in older adult clients. Which of the following manifestations should the nurse include in the teaching?

Correct Answer is D

Explanation

A nurse is preparing to administer fentanyl 100 mcg via IV bolus to a client who is postoperative and is currently receiving 0.9% sodium chloride by continuous IV infusion. Which of the following actions should the nurse take?

Correct Answer is B

Explanation

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