Aspirin 81 mg at 0900 daily is prescribed for an adult client. At 0800 the client asks for something for low back pain, but does not have any PRN analgesics prescribed. Which action is best for the nurse to take?
Wait until 0830 and administer the aspirin.
Obtain a prescription for a PRN analgesic.
Assess the client's prothrombin time (PT)/international normalized ration (INR).
Administer the prescribed daily aspirin now.
The Correct Answer is B
Choice A rationale: Waiting until 0830 and administering the aspirin would not address the client's immediate need for pain relief.
Choice B rationale: Obtaining a prescription for a PRN analgesic is the most appropriate action to provide the client with effective pain relief.
Choice C rationale: Assessing the client's prothrombin time (PT)/international normalized ratio (INR) is not necessary in this context and does not address the immediate pain concern.
Choice D rationale: Administering the prescribed daily aspirin now would not address the client’s lower back pain at the moment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale: Placing an isolation cart outside the room is important, because mumps is a contagious viral infection that can be transmitted by respiratory droplets from coughing or sneezing. This intervention prevents the spread of infection and protects other clients and staff from exposure.
Choice B rationale: Instructing the child's parents about the need for transmission precautions is essential for preventing the spread of mumps to other individuals but the most important intervention is to place an isolation cart outside the room. Choice C rationale: Scheduling bedside playtime with the occupational therapist may be beneficial for the child but is not the most critical intervention in preventing transmission.
Choice D rationale: Assigning the child to a room close to the nurse's station may facilitate monitoring but does not directly address the prevention of transmission.
Correct Answer is B
Explanation
Choice A rationale: The assessment is the client's signed power of attorney and a home medication list, which are important documents that indicate the client's wishes and potential drug interactions. While the client's healthcare power of attorney is important information, the reason for admission should be provided first to give context to the situation.
Choice B rationale: The nurse should start by presenting the immediate situation or concern, which is the client's increasing confusion which needs immediate attention. Choice C rationale: The recommendation is the nurse's suggestion for further diagnostic tests, interventions, or referrals based on the situation, background, and assessment. The currently prescribed medications are relevant, but the primary reason for admission should be communicated first to establish the context of the client's condition. Choice D rationale: The background is the fall at home as the reason for admission, which explains the possible cause of the confusion and the loss of consciousness. This comes after the situation which is the increasing confusion.
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