A charge nurse in a long-term care facility notices the smell of alcohol on a nurse's breath. Which of the following actions should the nurse take first?

Call the supervisor to ask for another nurse.

Assign clients to the remaining staff.

Document objective findings about the situation.

Remove the nurse from the client care area.

Answer and Explanation

The Correct Answer is D

The presence of alcohol on a nurse's breath raises concerns regarding impairment and the potential for compromised patient safety. It is crucial to prioritize patient safety and prevent any potential harm. Removing the nurse from the client care area ensures that immediate patient safety is addressed and minimizes the risk of any adverse events.

Call the supervisor to ask for another nurse: While involving the supervisor is important, it should not be the first action taken in this situation. The immediate priority is to address patient safety by removing the nurse from the client care area.

Assign clients to the remaining staff: Assigning clients to the remaining staff should not be the first action taken because it may compromise patient safety if the nurse in question is impaired. It is important to ensure that the nurse is removed from the client care area before reassigning the clients to other staff members.

Document objective findings about the situation: Documenting the objective findings about the situation is important for accurate record-keeping and reporting. However, it should not be the first action taken when immediate patient safety is at stake. Removing the nurse from the client care area is the priority.

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Correct Answer is A

Explanation

A nurse caring for a client who is receiving total parenteral nutrition should identify that a serum calcium level of 12.5 mg/dL indicates a possible complication of this therapy. Total parenteral nutrition can result in electrolyte imbalances, including hypercalcemia (high levels of calcium in the blood).

The other laboratory results are within normal ranges and do not indicate a complication of total parenteral nutrition.

b) A BUN level of 16 mg/dL is within the normal range.

c) A serum potassium level of 4.6 mEq/L is within the normal range.

d) A WBC count of 8,000/mm³ is within the normal range.

A. Hgb 12 g/dL B. Platelet count 90,000/mm3 C. Hematocrit 37% D. Creatinine 0.7 mg/dL

Correct Answer is B

Explanation

b. Platelet count 90,000/mm3.

Explanation:

During pregnancy, it is important to monitor the client's platelet count because a low platelet count can indicate a condition called gestational thrombocytopenia or other potential complications such as preeclampsia or HELLP syndrome. A platelet count of 90,000/mm3 is lower than the normal range and should be reported to the provider for further evaluation and management.

Option a, Hgb 12 g/dL, falls within the normal range for hemoglobin during pregnancy, which is typically between 11-13.5 g/dL. Therefore, it does not require immediate notification to the provider.

Option c, Hematocrit 37%, also falls within the normal range for hematocrit during pregnancy, which is typically between 33-42%. Therefore, it does not require immediate notification to the provider.

Option d, Creatinine 0.7 mg/dL, is within the normal range for creatinine levels and does not indicate any immediate concerns or need for notification to the provider.

It is important to remember that the interpretation of laboratory results should be done in the context of the client's individual clinical presentation and the healthcare provider's assessment. Any concerns or abnormal findings should be communicated to the provider for further evaluation and appropriate management.

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A charge nurse in a long-term care facility notices the smell of alcohol on a nurse's breath. Which of the following actions should the nurse take first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is receiving total parenteral nutrition. Which of the following laboratory results indicates a possible complication of this therapy?

Correct Answer is A

Explanation

A nurse is reviewing the laboratory results for a client who is at 32 weeks of gestation. For which of the following results should the nurse notify the provider?

Correct Answer is B

Explanation

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