A non-critical care nurse is part of the team in a "code blue resuscitation effort. The medical resident hands the nurse an unlabeled syringe and says. Give this to the client IV push STAT Whet response by the nurse appropriate in this emergency situation
"I will not give this substance because i did not prepare
“Since it is an emergency, how fast should I push this medication?
“I need to flush the saline lock first to make sure the IV is patent
"I will give it, but please write the order as soon as you're finished here"
The Correct Answer is B
B. This response acknowledges the urgency of the situation and seeks clarification on the appropriate administration technique. It demonstrates readiness to follow through with the medical resident's directive while ensuring safe and effective administration.
A. This response reflects hesitation and a concern about administering a medication that the nurse did not prepare or is unfamiliar with. In a critical situation like a "code blue," timely administration of medications as directed by the medical team is crucial for patient outcomes.
C. Checking IV patency is important to ensure the medication can be administered properly. However, in a "code blue" situation where time is critical, this step might unnecessarily delay administration of the medication.
D. This response indicates willingness to follow the directive given by the medical resident. It also emphasizes the importance of documenting and obtaining proper orders after the immediate crisis has been addressed.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
C. This option correctly identifies therationale behind the nurse's instruction. Immunosuppressed clients have a weakened immune system, making them highly vulnerable to infections. Family members may carry microorganisms on their hands, clothes, or respiratory secretions that can potentially transmit infections to the client. Wearing gloves and a mask helps reduce the risk of introducing pathogens to the client.
A. This option suggests that the risk is related to hospital staff transmitting infections to family members. While this is a concern in healthcare settings, it is not directly related to the specific situation described where family members are visiting an immunosuppressed client in a protective environment.
B. This option implies that the hospital environment itself poses a risk of infection transmission to family members. While hospitals can harbor various pathogens, the primary concern in this scenario is the transmission of infections to the immunosuppressed client from outside sources, including family members.
D. This option suggests that the client could transmit infections to family members. While this is theoretically possible depending on the specific infectious agent and the client's condition, the primary concern in a protective environment is preventing infections from entering the client's environment and affecting their health.
Correct Answer is A
Explanation
A. By critically thinking about client care, nurses can assess situations, analyze data, evaluate options, and make informed decisions that contribute to the delivery of high-quality care. Critical thinking helps nurses identify priorities, anticipate potential complications, and adapt care plans based on individual client needs and responses.
B. While critical thinking is important in research and evidence-based practice, its primary role in client care is to ensure that nursing interventions are well-reasoned, evidence-based, and tailored to meet the specific needs of clients. While clients may benefit indirectly from evidence-based care resulting from nursing research, client care primarily focuses on immediate clinical decision-making and management.
C. Critical thinking involves analyzing various aspects of client care, including physiological, psychological, and social phenomena. By critically analyzing these phenomena, nurses can understand underlying issues, identify contributing factors to health conditions, and determine appropriate nursing interventions to promote health and well-being. This process helps nurses make sense of complex client situations and provide holistic care.
D. Critical thinking enables nurses to consider multiple options or strategies for nursing actions. By critically evaluating these options based on client assessment data, evidence-based practice guidelines, and ethical principles, nurses can make informed decisions about the most effective and appropriate interventions for their clients. This ensures that nursing care is individualized and responsive to the unique needs and preferences of each client.
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