The licensed nurse is unable to complete medication administration within the accepted time limits. The licensed nurse reviews time management strategies with the lead nurse and reports difficulty with interruptions and call-lights. Which strategy should the lead nurse recommend to improve on-time medication administration?
Avoid procrastination.
Decrease distractions.
Set boundaries.
Set goals.
The Correct Answer is B
A. Avoiding procrastination is a general time management principle; however, the nurse has specifically identified interruptions and call lights as the main barriers, not delay in starting tasks. Therefore, this strategy does not directly address the root cause of the problem.
B. The nurse is experiencing frequent interruptions and distractions, which are known to significantly impact medication safety and timeliness. Decreasing distractions—such as using “no interruption” zones, wearing medication administration vests, delegating non-urgent call lights, or minimizing unnecessary interruptions—helps the nurse maintain focus, reduce errors, and complete medication administration within the required time frame. This directly targets the identified issue.
C. Setting boundaries can be helpful in managing workload and communication; however, it is less specific than decreasing distractions and may not fully address the immediate issue of interruptions during medication administration. While related, it is not the most direct or effective strategy in this context.
D. Setting goals is a broad time management approach that helps with planning and prioritization. However, the nurse’s difficulty is not due to lack of goals but rather frequent interruptions. Therefore, this option does not specifically resolve the problem affecting medication administration timing.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is []
Explanation
Rationale for Correct Choices
• Heart failure with COPD exacerbation: The client has a history of both HF and COPD and presents with classic signs of exacerbation of both conditions: dyspnea, hypoxia (SpO₂ 87% on oxygen), wheezing (COPD), crackles, S3/S4 heart sounds, and jugular vein distention (HF). The recent URI and steroid use likely triggered the COPD exacerbation, while fluid overload contributes to HF symptoms.
• Initiate diuretic therapy: Diuretics are indicated due to signs of fluid overload (JVD, crackles, S3/S4). Reducing excess fluid improves pulmonary congestion and breathing.
• Draw arterial blood gas (ABG) level: ABG analysis is critical in COPD exacerbation to assess oxygenation, carbon dioxide retention, and acid-base status, guiding oxygen therapy and potential ventilatory support.
• Fluid volume status: Monitoring intake/output, weight, and signs of overload helps evaluate response to diuretics and overall HF management.
• Signs of electrolyte imbalance: Diuretics can cause electrolyte disturbances (e.g., hypokalemia), which can worsen cardiac and respiratory status, so close monitoring is essential.
Rationale for Incorrect Choices
• Pneumonia: Although fever and productive cough are present, the dominant findings (JVD, S3/S4, chronic COPD history, fluid overload signs) point more strongly to HF with COPD exacerbation rather than isolated pneumonia.
• Pulmonary embolism: PE typically presents with sudden onset dyspnea, pleuritic chest pain, and clear lung sounds; this client has wheezing, crackles, and infection-related symptoms.
• Myocardial infarct: Chest heaviness is present, but there are no hallmark ECG changes or primary cardiac ischemic symptoms; respiratory findings and history better support HF/COPD exacerbation.
• Initiate intravenous antibiotics: While infection may be present, antibiotics are not the immediate priority compared to stabilizing airway, breathing, and fluid overload.
• Collect sputum for culture and sensitivity: Useful for infection identification but not the priority in acute respiratory compromise.
• Draw troponin levels: Not the priority unless strong suspicion of myocardial infarction exists.
• White blood cells (WBC): May be elevated but is not the primary indicator of improvement for HF/COPD exacerbation.
• Antibiotic blood levels: Not relevant unless specific antibiotics requiring monitoring are initiated.
• Development of acute kidney injury: Important to consider but not the primary parameter for assessing immediate improvement in this condition.
Correct Answer is D
Explanation
A. Crackles may indicate fluid accumulation in the lungs due to left-sided heart failure, which can occur in chronic aortic regurgitation. While important, crackles develop gradually and may not indicate immediate hemodynamic instability.
B. A soft S1 is a common finding in aortic regurgitation due to premature closure of the mitral valve. This is expected and chronic in nature, and while it should be documented, it does not represent an acute change requiring immediate intervention.
C. Although bradycardia may affect cardiac output, it is less immediately threatening compared to hypotension unless severe or symptomatic. It is not the most urgent change in this context.
D. This is the most critical finding to report immediately. Aortic valve regurgitation can compromise forward cardiac output, and hypotension may indicate acute decompensation, cardiogenic shock, or severe regurgitation, which is life-threatening. Prompt notification allows for urgent assessment, possible medication adjustments, or advanced interventions to stabilize the client.
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