A nurse working in a long-term care facility is assigned to care for four clients following the 0700 morning change-of-shift report. Which of the following clients should the nurse attend to first?
A client who has bronchitis, began receiving antibiotics yesterday and has a temperature of 38.3°C (101°F).
A client who has COPD and has an oxygen saturation of 90%.
A client who has Alzheimer's and was restless during the night.
A client who has diabetes and had a 0600 blood glucose level of 60 mg/dL.
The Correct Answer is D
Of the four clients described, the nurse should attend to the client who has diabetes and had a 0600 blood glucose level of 60 mg/dL first. This client's blood glucose level is low and requires immediate intervention to prevent further complications.
Option A may require attention, but the client's condition is stable and they are receiving treatment.
Option B may also require attention, but an oxygen saturation of 90% is within an acceptable range for a client with COPD.
Option C may also require attention, but the client's restlessness during the night does not indicate an immediate need for intervention.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C","E"]
Explanation
SBAR stands for Situation, Background, Assessment, and Recommendation. It is a systematic method of communication that provides a structured framework for conveying important information about a patient. To ensure that the report is thorough, the nurse needs to include information about the situation of the patient, the background leading up to the situation, an assessment of the patient, and recommendations for moving forward.
Option d is incorrect because barriers to providing treatment are not part of the SBAR framework.
Option f is incorrect because the reason why the report is needed is not part of the SBAR framework.
Correct Answer is A
Explanation
The principle associated with the responsibility of nurses for their actions and the actions of the staff to whom they delegate work, including accurate documentation, is accountability. This means that nurses are responsible for ensuring that the care provided by themselves and their staff meets the appropriate standards and that all documentation is accurate and complete.
Option B is incorrect because conflict resolution is a process for resolving disagreements or disputes.
Option C is incorrect because coordination of care refers to the process of organizing and managing a patient's healthcare needs.
Option D is incorrect because authoritativeness refers to the ability to make decisions and provide direction.
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