A nurse is providing change-of-shift report on a client who is postoperative following abdominal surgery. Which of the following statements should the nurse include in the change-of-shift report?
"The client's postoperative antibiotic was administered."
"The client's partner came to visit today."
"At 2200, the client's IV fluid bag and tubing will need replacing."
"Colonoscopy was performed 48 hours ago."
The Correct Answer is C
A. "The client's postoperative antibiotic was administered." While this information is important, it is not typically included in the change-of-shift report unless there were specific issues related to antibiotic administration (e.g., allergic reactions, missed doses).
B. "The client's partner came to visit today." While this information might be relevant to the client’s social and emotional well-being, it is not critical for the shift report regarding clinical care.
C. "At 2200, the client's IV fluid bag and tubing will need replacing." This statement is important for continuity of care and should be included in the report to ensure that the next shift is aware of necessary actions.
D. "Colonoscopy was performed 48 hours ago." This information is relevant for understanding the client’s postoperative status but is less immediate compared to other details such as current medication administration or upcoming needs.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Avoid using moisturizers on the client's skin. Moisturizers are important for maintaining skin integrity, especially in clients with incontinence, to prevent skin breakdown.
B. Place the client on a timed voiding schedule. This is correct. A timed voiding schedule can help manage incontinence by reducing the frequency of wetness and thereby preventing skin breakdown.
C. Place the client in high-Fowler's position while in bed. High-Fowler’s position is not typically indicated for preventing skin breakdown and can increase pressure on the sacral area.
D. Wash urine off the client's skin with hot water and soap. Washing with hot water and soap can be harsh and irritating to the skin. It is better to use mild soap and lukewarm water.
Correct Answer is C
Explanation
A. Hyperthyroidism generally affects metabolism and does not typically cause dysphagia.
B. Arthraiga refers to joint pain and is not directly associated with dysphagia.
C. Mutiple sclerosis: This is correct. Multiple sclerosis is a neurological condition that can cause muscle weakness, coordination issues, and difficulty swallowing, all of which are factors in dysphagia.
D. Crohn's disease primarily affects the gastrointestinal tract and does not typically cause dysphagia.
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