During the admission assessment to the hospital, a male client reports that he is allergic to latex, penicillin, and bananas. Which intervention should the nurse implement first?

Send a list of medication allergies to the pharmacy.

Secure an allergy bracelet around the client's wrist.

Notify the dietary department of the client's fruit allergy.

Place a latex-free supply cart outside the client's room.

Answer and Explanation

The Correct Answer is B

A. Sending a list of medication allergies to the pharmacy is important for preventing adverse drug reactions but is not the immediate priority upon admission.
B. Securing an allergy bracelet around the client's wrist is the first action to ensure that all healthcare providers are immediately aware of the client's allergies, which is crucial for preventing accidental exposure to allergens.
C. Notifying the dietary department is important to prevent allergic reactions from food, but addressing the most immediate concern ensuring the client’s allergies are known to all involved in their care is a higher priority.
D. Placing a latex-free supply cart outside the room is important for preventing latex exposure but is secondary to ensuring that the client’s allergies are clearly communicated through an allergy bracelet.

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Correct Answer is A

Explanation

A. Suggesting a stool softener is appropriate as it helps to ease bowel movements and reduce straining, which can alleviate pain associated with hemorrhoids and help establish a regular bowel pattern.
B. Recommending a daily laxative may not be appropriate for long-term use and could potentially exacerbate the issue if overused. It is generally better to start with less invasive measures like stool softeners.
C. Obtaining a stool specimen may be necessary for diagnostic purposes but does not directly address the immediate concern of painful defecation due to hemorrhoids.
D. Discussing oral analgesic options might help with pain management, but it does not address the underlying issue of constipation and the need for a regular bowel pattern. Stool softeners are more directly related to resolving the constipation problem.

A. Consult the palliative care team about the client's care. B. Set up a family conference to discuss the client's wishes. C. Discuss with the client her meaning of heroic measures. D. Obtain a "do not resuscitate" (DNR) prescription.

Correct Answer is C

Explanation

A. While consulting the palliative care team is appropriate for end-of-life care, it is essential first to clarify the client's understanding and wishes regarding "heroic measures" to ensure her preferences are fully understood and respected.
B. Setting up a family conference is important for discussing the client’s wishes with her loved ones, but this should occur after the nurse understands the client's specific desires.
C. The nurse should first discuss with the client what she means by "heroic measures" to ensure that her wishes are clearly understood. This conversation is essential to ensure that any subsequent actions, such as obtaining a DNR order, align with the client’s specific wishes.
D. A DNR prescription is an important step in respecting the client's wishes, but it should only be obtained after confirming exactly what the client means by "heroic measures" and ensuring that she fully understands the implications of a DNR order.

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During the admission assessment to the hospital, a male client reports that he is allergic to latex, penicillin, and bananas. Which intervention should the nurse implement first?

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Naxlex Comprehensive Predictor Exams

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