The nursing assessment finding that represents the most serious indication of a client's deteriorating oxygenation status is:

pursed-lip breathing.

clubbing of the nails.

cyanosis.

poor skin turgor.

Answer and Explanation

The Correct Answer is C

Choice A rationale: Pursed-lip breathing is a compensatory mechanism to improve oxygenation and is not as severe an indication as cyanosis.

Choice B rationale: Clubbing of the nails is a chronic sign of oxygenation issues but may not be an acute and immediate indication of deterioration.

Choice C rationale: Cyanosis, the bluish discoloration of the skin and mucous membranes, is a serious indication of inadequate oxygenation.

Choice D rationale: Poor skin turgor is not a direct indicator of oxygenation status.

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Correct Answer is C

Explanation

Choice A rationale: R/O (rule out) is not appropriate for documenting the client's current presentation.

Choice B rationale: S/P (status post) is not appropriate for describing the client's current respiratory distress.

Choice C rationale: SOB (shortness of breath) is the correct abbreviation to document the client's difficulty in breathing.

Choice D rationale: DOB (date of birth) is not relevant to the client's respiratory distress.

A. administration can predict overtime costs more accurately. B. skills of the nursing team can be used more effectively. C. clients receive less attention because there are too many staff members involved in the care. D. nurses report more pressure to perform necessary tasks themselves.

Correct Answer is B

Explanation

Choice A rationale: Administration predicting overtime costs is not a recognized advantage of delegation.

Choice B rationale: Skills of the nursing team can be used more effectively, allowing tasks to be delegated to the appropriate individuals and promoting efficient care delivery.

Choice C rationale: Clients do not necessarily receive less attention due to delegation if it is done effectively.

Choice D rationale: Nurses reporting more pressure to perform necessary tasks themselves is not a recognized advantage of delegation.

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The nursing assessment finding that represents the most serious indication of a client's deteriorating oxygenation status is:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client is recently diagnosed with pneumonia. The nurse observes the client sitting upright in the bed and assesses a respiratory rate of 26. The client states, "I can't catch my breath." Which abbreviation would be used to document this presentation?

Correct Answer is C

Explanation

An advantage of delegation in client care is that:

Correct Answer is B

Explanation

The nurse knows that which form of medication delivery results in the most predictable onset and most bioavailability to the client?

The nurse finds a client on bed rest experiencing clear signs of dyspnea. The nurse should assist the client to a:

The nurse recognizes that the application of heat therapy is appropriate for which client? The client who:

It is most critical for the nurse to use a filtered needle when preparing a parenteral medication that:

The nurse understands that the rationale(s) for clients receiving intravenous (IV) therapy is/are to: (SELECT ALL THAT APPLY)

The nurse receives the following order: "Ferrous sulfate 325 mg four times a day PO. Give on empty stomach." Even before researching, the nurse guesses that this is because the medication:

The nurse is transcribing a medication order and schedules dosing for 10:00 AM, 2:00 PM and 6:00 PM. Which medication order is consistent with this schedule?

The nurse is aware that a common cause of under delegation in client care is: