A nurse is providing change-of-shift report for an oncoming nurse. Which of the following information should the nurse include in the report?
"The client is the president of a local bank,"
"The client's partner came to visit him 2 hours ago."
"The client has routine vital signs prescribed."
"The client is in the radiology department for a chest x-ray."
The Correct Answer is D
A. Mentioning that the client is the president of a local bank might not be pertinent to the client's current health status or care needs and is not typically included in a change-of- shift report unless relevant to the care plan.
B. The fact that the client's partner came to visit two hours ago might be important for emotional support or social interaction but might not be crucial information for the oncoming nurse unless relevant to the client's condition.
C. The client has routine vital signs prescribed” is not as critical to include in the change-of-shift report because it is standard practice and does not provide specific, immediate information about the client’s current status or any changes that need to be monitored closely.
D. This is critical information for the incoming nurse. It informs them that the client is currently away from the unit, which may affect the plan of care, including monitoring, medication administration, or any interventions needed during the client’s absence. It is important for the incoming nurse to be aware of the client's current status and whereabouts.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Implementing a fall prevention plan is an important step but comes after identifying those at risk.
B. Reviewing current literature is important for understanding evidence-based practices, but it should come after identifying and assessing the specific risk factors in the facility.
C. Notifying staff of the increased fall rate is essential but doesn't directly address the root cause; it's more reactive than proactive.
D. Identifying clients who are at risk for falls is the initial step to intervene and prevent further incidents, forming the foundation for a targeted fall prevention plan.
Correct Answer is D
Explanation
A. Referring the adult child to the primary care provider might not immediately address the information needed.
B. Directing the adult child to speak solely with the mother might not be the most helpful approach to gather necessary information.
C. Inviting the adult child to specify what information they seek is not correct as they would have to get this information from their mother or their mother wil have to consent.
D. It is the role of the nurse to inform the child that they cannot disclose that information since patient confidentiality is a priority.
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