A nurse realizes that the wrong medication has been administered to a client. Which of the following actions should the nurse take first?

Fill out an incident report.

Report the incident to the nurse manager.

Notify the provider.

Measure the client's vital signs.

Answer and Explanation

The Correct Answer is D

A. Fill out an incident report. While completing an incident report is necessary for documentation and quality improvement, it is not the priority action. The nurse must first assess the client's condition to address any immediate risks.
B. Report the incident to the nurse manager. Informing the nurse manager is important for accountability and follow-up, but client safety and assessment come first before escalating the issue to management.
C. Notify the provider. The provider should be informed after the nurse has assessed the client and gathered relevant data such as vital signs. This allows the provider to make informed decisions about further treatment or monitoring.
D. Measure the client's vital signs. Assessing the client is the first priority following a medication error to identify any adverse effects. Vital signs provide immediate data on the client’s physiological status and guide urgent interventions if needed.

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Correct Answer is C

Explanation

A. Apply splints to the child's extremities during the day. Splints are typically used at night to help prevent joint contractures and support proper alignment during rest. Daytime use may limit mobility and physical activity, which are encouraged.
B. Encourage the child to take naps during the day. While rest is important, excessive daytime napping can contribute to joint stiffness and reduced function. Activity and movement are encouraged to maintain joint flexibility.
C. Have the child take a tub bath each morning. Warm baths help relieve joint stiffness and pain associated with juvenile idiopathic arthritis. Morning bathing is especially beneficial to improve mobility at the start of the day.
D. Keep the child on bedrest as long as pain persists. Prolonged bedrest can lead to muscle atrophy, stiffness, and joint contractures. Maintaining activity, as tolerated, is key to managing symptoms and preserving joint function.

A. Vital signs B. Prescribed diet C. Skin appearance D. Blood glucose level E. WBC count

Correct Answer is ["A","C","D"]

Explanation

A. Vital signs. The client has a significantly elevated heart rate (110/min) and elevated blood pressure (178/82 mm Hg), both of which can be associated with autonomic responses in dumping syndrome. The dizziness and desire to lie down after eating are also classic symptoms. These signs reflect the body’s reaction to rapid gastric emptying and fluid shifts.
B. Prescribed diet. While a bland, soft diet is generally safe post-gastrectomy, it may not prevent dumping syndrome unless it includes specific modifications like low carbohydrate intake and small, frequent meals. However, this option alone does not directly indicate dumping syndrome.
C. Skin appearance. The client is noted to be diaphoretic and pale, which are common symptoms of dumping syndrome due to the vasomotor response and hypoglycemia that can follow rapid gastric emptying.
D. Blood glucose level. The client's fasting blood glucose dropped to 65 mg/dL, which is below the normal range. Hypoglycemia is a hallmark of late dumping syndrome, resulting from excessive insulin release after rapid carbohydrate absorption in the small intestine.
E. WBC count. The WBC count is within normal range (9,000/mm³) and does not indicate dumping syndrome or an infectious process. It is not relevant in this context.

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A nurse realizes that the wrong medication has been administered to a client. Which of the following actions should the nurse take first?

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Naxlex Comprehensive Predictor Exams

A nurse is teaching the parents of a school-age child who is newly diagnosed with juvenile idiopathic arthritis. Which of the following interventions should the nurse include in the teaching?

Correct Answer is C

Explanation

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Correct Answer is ["A","C","D"]

Explanation

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