What data are necessary to compile an effective end-of-shift report? (Select all that apply.)

Patients mental status

All pertinent nursing care

Visitors the patient had during the shift

Status of lung sounds

The patients favorite TV shows

Answer and Explanation

Correct Answer : A,B,D

A.   The patient's mental status is crucial for understanding their current cognitive and emotional condition. This information helps the incoming nurse assess whether there have been any changes or concerns regarding the patient's orientation, mood, or cognitive function.
B.   Documenting all pertinent nursing care provides a comprehensive overview of what has been done for the patient during the shift, including any treatments, medications administered, and changes in the patient's condition.
C.   While knowing who visited the patient might be relevant in some contexts, it is generally not a core component of clinical shift reports unless the visitors' presence impacted patient care or the patient’s condition. This information is usually not necessary for the shift report unless it directly affects the
patient’s care or treatment, such as if a visitor brought important information or had a significant impact on the patient.

D.   The status of lung sounds is a specific aspect of the patient's physical assessment and can indicate respiratory issues or improvements. This data is necessary if the patient has a respiratory condition or if there have been recent changes in their respiratory status. It helps the incoming nurse evaluate the effectiveness of treatments and ongoing respiratory care.
E.   Information about the patient's favorite TV shows is not relevant to clinical care and does not impact
the patient’s health status or the nursing interventions required. This information is not necessary for
the shift report as it does not contribute to the patient’s medical or care needs.

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

Explanation

A. This option is relevant to primary disease prevention because it aims to prevent smoking-related diseases before they occur. By providing information about smoking cessation support groups, the nurse helps the patient reduce or eliminate a major risk factor for many serious diseases, including cancer and cardiovascular disease. This aligns with the goals of primary prevention.

B.A This option is a form of primary disease prevention. The influenza vaccination helps prevent the flu before it starts, thus reducing the risk of illness and its complications. Vaccinations are a classic example of primary prevention, as they protect against diseases before they occur.
C. This option also aligns with primary disease prevention. Teaching the patient about dietary changes to manage hypertension can help prevent the development of hypertension-related complications such as heart disease or stroke. By addressing dietary habits before hypertension develops, this intervention supports primary prevention.
D. This option is not primarily a primary prevention measure. Occult stool screening kits are used for early detection of colorectal cancer, which is more about secondary prevention. Secondary prevention focuses on early detection and intervention to reduce the impact of a disease once it has already developed but before symptoms appear.
E. This option represents primary disease prevention. The pneumococcal vaccine helps prevent pneumonia and other serious infections caused by pneumococcal bacteria. Vaccination, especially in older adults, is an effective method to prevent illness before it occurs, fitting the primary prevention category.

A. Reporting muscle aches and frequent stumbling B. Dozing off in chair and not recognizing staff C. Pulse. 118 beats/min; and BP 160/90 D. Pulse, 58 beats/min; and BP 100/60

Correct Answer is C

Explanation

A. While these symptoms can be associated with alcohol withdrawal, they are not as indicative of an immediate medical emergency as tachycardia and hypertension.
B. While these symptoms may suggest cognitive impairment, they are not as indicative of impending alcohol withdrawal syndrome as tachycardia and hypertension.
C. Alcohol withdrawal can lead to various physiological changes, including increased heart rate and blood pressure. A pulse of 118 beats/min and a blood pressure of 160/90 indicate a significant increase in both vital signs, which could be a sign of impending alcohol withdrawal syndrome.
D. These vital signs are within normal limits and do not indicate a significant risk of alcohol withdrawal syndrome.

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What data are necessary to compile an effective end-of-shift report? (Select all that apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse planning primary disease prevention interventions for a 64-year-old patient includes which of the following? Select all that apply.

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

Explanation

The nurse is assessing patients for impending alcohol withdrawal. The nurse assesses the patient with which of the following conditions as a priority?

Correct Answer is C

Explanation

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