The nurse receives an order for a medication that will assist the client at bedtime. The abbreviation for the best time to administer this medication is:

HOB

HOH

Answer and Explanation

The Correct Answer is B

A. HOB (Head of Bed): This abbreviation refers to the position of the client's bed and does not indicate a specific time for medication administration. It stands for "Head of Bed" and is often used in nursing documentation to describe the elevation of the head of the bed relative to the client's body.

B. hs: This is the correct abbreviation. "hs" stands for "hora somni" in Latin, which translates to "at bedtime." It indicates that the medication should be administered to the client before they go to sleep for the night. This abbreviation is commonly used in medication orders and nursing documentation to specify the timing of medications given at bedtime.

C. hr: This abbreviation stands for "hour," indicating a specific time frame rather than a particular time of day. It does not specify bedtime as the intended time for medication administration.

D. HOH (Hard of Hearing): This abbreviation refers to the client's auditory status and does not indicate a specific time for medication administration. It stands for "Hard of Hearing" and is used to describe clients who have difficulty hearing.

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Correct Answer is D

Explanation

A. Type of diet: While the type of diet may be relevant to the overall health and well-being of the older adult client, it may not directly contribute to understanding the change in mental status. While nutritional deficiencies or imbalances could potentially impact mental status, other factors are more immediately relevant to assessing the change in mental status.

B. Cultural considerations: Cultural considerations are important in providing holistic care to the older adult client, but they may not directly contribute to understanding the change in mental status. Cultural factors could influence communication styles, beliefs about health and illness, and preferences for care, but they may not be the primary focus when assessing a change in mental status.

C. Gender: Gender may have some relevance to the overall health and well-being of the older adult client, but it may not directly contribute to understanding the change in mental status. While certain gender-related factors, such as hormonal changes or gender-specific health conditions, could potentially impact mental health, they may not be the primary focus when assessing a change in mental status.

D. History of onset: This represents a critical thinking approach because understanding the history of onset of the change in mental status is essential for identifying potential causes and determining appropriate interventions. The timing and circumstances surrounding the onset of the change can provide valuable information about possible contributing factors, such as recent illnesses, medication changes, trauma, or environmental changes. By gathering information about the history of onset, the nurse can engage in critical thinking to formulate hypotheses, prioritize assessments, and develop a plan of care tailored to the client's needs.

A. 4 in. (10.2 cm) B. 5 in (12.7 cm) C. 6 in. (15.25 cm) D. 2 in. (5.1 cm) E. 3 in. (7.6 cm)

Correct Answer is ["A","E"]

Explanation

When administering an enema to an adult patient with constipation, the nurse must insert the tubing into the patient's rectum to deliver the enema solution effectively. However, it's crucial to avoid inserting the tubing too far to prevent injury or discomfort to the patient. The recommended insertion distance varies depending on the individual patient's anatomy and the type of enema being administered.

A. 4 in. (10.2 cm):

Inserting the enema tubing approximately 4 inches (10.2 cm) into the patient's rectum is considered a safe and effective distance for most adult patients. This depth allows the enema solution to reach the sigmoid colon, facilitating the evacuation of stool and relieving constipation without risking insertion too deeply into the rectum.

B. 5 in (12.7 cm): Inserting the tubing 5 inches into the rectum is generally deeper than necessary and may increase the risk of injury or discomfort. This distance is not typically recommended for safe and effective administration of an enema.

C. 6 in. (15.25 cm): Inserting the tubing 6 inches into the rectum is deeper than necessary and may increase the risk of injury or discomfort. This distance is generally not recommended for safe and effective administration of an enema.

D. 2 in. (5.1 cm): Inserting the tubing 2 inches into the rectum is not considered a safe and effective distance for many adult patients. This distance does not allow for the effective delivery of the enema solution into the lower rectum and sigmoid colon without inserting the tubing too far.

E. 3 in. (7.6 cm): Inserting the tubing 3 inches into the rectum is also considered a safe and effective distance for many adult patients. This distance allows for the delivery of the enema solution into the lower rectum and sigmoid colon without inserting the tubing too far.

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The nurse receives an order for a medication that will assist the client at bedtime. The abbreviation for the best time to administer this medication is:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

An older adult client experiences a change in mental status. Which assessment finding represents a critical thinking approach?

Correct Answer is D

Explanation

The nurse must administer an enema to an adult patient with constipation. Which is a safe and effective distance for the nurse to insert the tubing into the patient's rectum? (SELECT ALL THAT APPLY)

Correct Answer is ["A","E"]

Explanation

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