A nurse on a med-surge unit is caring for four clients. The nurse should recognize that which of the following clients is the priority?

A client who is postoperative following a laminectomy 12 hour and is unable to void

A client who is scheduled for a tubal ligation in 2 hours and is crying

A client who has peripheral vascular disease and has an absent pulse in the right foot

A client who has type 1 diabetes and needs the first dressing change for an ulcer

Answer and Explanation

The Correct Answer is C

A. Postoperative urinary retention is common after surgery, especially within the first 12 hours. While this requires monitoring and possible intervention, it is not the highest priority.
B. Emotional distress before surgery is important to address, but it is not an immediate physiological concern requiring urgent intervention.
C. An absent pulse in the right foot indicates potential acute arterial occlusion, which is a medical emergency. This condition can lead to tissue ischemia and necrosis if not treated promptly. Immediate intervention is needed to restore circulation.
D. A dressing change for a diabetic ulcer is important for wound healing and infection prevention, but it does not take priority over a potential loss of circulation.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is A

Explanation

a. Postoperative care, especially for a client with a PCA pump (Patient-Controlled Analgesia), requires skills commonly found in medical-surgical units, making it suitable for an RN with experience in that area.
b. Managing preeclampsia and labor induction involves obstetric-specific knowledge and skills, which are better suited for a nurse with experience in obstetrics.
c. Gestational diabetes management and nonstress tests are part of routine obstetrical care and do not necessarily require specialized medical-surgical skills.
d. A client with premature rupture of membranes at 32 weeks gestation requires close monitoring and potentially specialized obstetric care, not typically provided by medical-surgical nurses.

A. Whether the client understands the risk of refusing the procedure B. Whether the partner is the client's durable power of attorney for health care C. Whether the client's refusal is based on a religious belief D. Whether the facility ethics committee reaches a consensus on the case

Correct Answer is A

Explanation

A: The autonomy of the patient is paramount in medical ethics. If the client understands the risks and still refuses the procedure, their choice must be respected. It is a fundamental right for patients to make informed decisions about their own healthcare.

B: While a durable power of attorney for health care is crucial when a patient is incapacitated, it does not override the wishes of a competent patient. As long as the client is capable of making decisions, their consent is required for any procedure.

C: Although religious beliefs are respected, they do not serve as the primary deciding factor if the client is competent. The client's understanding and decision-making capacity are the key determinants in whether to proceed with the surgery.

D: The ethics committee can provide guidance on complex cases, but it cannot make decisions for a competent patient. The committee's role is advisory, and the final decision rests with the patient.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

A nurse on a med-surge unit is caring for four clients. The nurse should recognize that which of the following clients is the priority?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A charge nurse on an obstetrical unit is preparing the shift assignment. Which of the following clients should be assigned to an RN who has floated from a medical-surgical unit?

Correct Answer is A

Explanation

A nurse is caring for a client who has a tumor. The provider recommends surgery. The client refuses, but the client's partner wants the surgery performed. Which of the following is the deciding factor in determining if the surgery will be done?

Correct Answer is A

Explanation

A nurse is assisting with the orientation of a newly licensed nurse. The newly licensed nurse is having trouble focusing and has difficulty completing care for his assigned clients. Which of the following interventions is appropriate?

A nurse manager is receiving report and is faced with the following situations that require intervention. Which of the following should the nurse manager address first?

A nurse is teaching a newly licensed nurse about client confidentiality. The nurse should include which of the following examples represents a violation of client confidentiality?

A nurse working in an emergency department is performing triage. To which of the following clients should the nurse assign priority?

A nurse is preparing a teaching session with a client who speaks a different language than the nurse. Which of the following interventions should the nurse plan to include?

A nurse is delegating care for a group of clients. Which of the following clients should the nurse assign to the LPN?

A nurse working on a quality improvement team that is assessing an increase in client falls at the facility. After problem identification, which of the following actions should the nurse plan to take first as part of the quality improvement process?

6) A nurse on a medica-surgical unit is caring for a client who asks about advance directives and states that he wants to appoint a health care proxy. Which of the following responses should the nurse make?