A nurse is preparing to give change-of-shift report to the oncoming nurse. Which of the following information should the nurse include?
Medical diagnosis.
Number of visitors.
Routine care.
Expected laboratory results.
The Correct Answer is A
A. Medical diagnosis:
This provides context for the patient’s condition and guides the next nurse in understanding care priorities.
B. Number of visitors:
This is not essential clinical information for continuity of care.
C. Routine care:
Routine care (like scheduled hygiene or linen changes) is generally not included unless there was a deviation or issue.
D. Expected laboratory results:
Only actual or pending critical results should be reported. “Expected” values are not useful unless they have been received and are relevant.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
This can be a sign of preeclampsia, a serious complication of pregnancy that causes high blood pressure and proteinuria.
The nurse should report this finding to the provider and monitor the client’s blood pressure, urine protein, and reflexes.
Choice A is wrong because leg cramps are a common discomfort during pregnancy and are not usually a sign of a complication.
Choice B is wrong because ptyalism, or excessive salivation, is a normal physiological change during pregnancy and does not indicate a problem.
Choice D is wrong because melasma, or darkening of the skin on the face, is also a normal physiological change during pregnancy and does not pose a risk to the mother or the fetus.
Correct Answer is B
Explanation
“I will not play soccer until my doctor tells me I can.” This statement indicates that the client understands the risk of splenic rupture due to splenomegaly and the need to avoid contact sports until the spleen returns to normal size.
Choice A is wrong because antibiotics are not effective for infectious mononucleosis, which is caused by a virus.
Choice C is wrong because varicella booster is not related to infectious mononucleosis and there is no evidence that the client needs it.
Choice D is wrong because jaundice (yellowing of the eyes and skin) is not a common manifestation of infectious mononucleosis and may indicate another condition such as hepatitis.
Normal ranges for spleen size are 7 to 14 cm in length and 3 to 4 cm in thickness.
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