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?
Document objective findings about the situation.
Assign clients to the remaining staff.
Call the supervisor to ask for another nurse.
Remove the nurse from the client care area.
The Correct Answer is D
Choice A Reason:
Document objective findings about the situation is incorrect. While documentation is important, it should not be the first action when the charge nurse suspects a colleague is under the influence of alcohol. Patient safety takes precedence, and immediate action to remove the nurse from patient care is necessary to prevent potential harm.
Choice B Reason;
Assigning clients to the remaining staff is incorrect. Assigning clients to other staff members is an appropriate step but should come after the nurse under suspicion has been removed from patient care to ensure their safety. Patient safety is the primary concern.
Choice C Reason:
Calling the supervisor to ask for another nurse is incorrect. Contacting the supervisor is a reasonable action, but it should be done after the immediate safety concern has been addressed by removing the nurse from patient care. This allows the supervisor to be informed of the situation and take appropriate action.
Choice D Reason:
Removing the nurse from the client care area is correct.When a charge nurse detects the smell of alcohol on a nurse's breath, the first and most immediate action should be to remove the nurse from the client care area to ensure patient safety. Alcohol impairment can severely compromise a nurse's ability to provide safe and effective care. Once the nurse is removed from patient care, further actions, such as documenting objective findings and contacting the supervisor, can be taken to address the situation and ensure appropriate follow-up, including any necessary interventions or investigations. Patient safety should always be the top priority in such situations.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
The recommended weight gain during pregnancy can vary depending on a woman's pre-pregnancy BMI (Body Mass Index).
For a client with a prepregnancy BMI of 30.5, the recommended weight gain is approximately 11 to 20 pounds. Therefore, none of the options A, B, C, are within this recommended range.
So, the nurse should inform the client that an acceptable weight gain for her would be between 11 to 20 pounds during her pregnancy.
Correct Answer is A
Explanation
Choice A Reason:
Digoxin can produce alterations in the visual system of patients, such as reduced visual acuity, photophobia, and blurred or yellow vision.
Choice B Reason:
While tinnitus can occur with various medications, it's not a specific symptom of digoxin toxicity.
Choice C Reason:
Joint pain is incorrect. Joint pain is not a common symptom of digoxin toxicity.
Choice D Reason:
Constipation is incorrect. Constipation is not typically associated with digoxin toxicity either.
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