A nurse in a long-term care facility has received change-of-shift report about four clients. Which of the following clients should the nurse attend to first?

A client who has heart failure and is incontinent of urine

A client who has COPD and dementia and was agitated during the night shift

A client who had a hip arthroplasty 10 days ago and reports pain with ambulation

A client who had a cerebrovascular accident 6 months ago and reports constipation

Answer and Explanation

The Correct Answer is B

The nurse should atend to the client who has COPD and dementia and was agitated during the night shift first. This client may be experiencing respiratory distress or other complications related to their COPD and requires immediate assessment and intervention.

a) A client who has heart failure and is incontinent of urine requires atention, but their needs are not as urgent as those of the client with COPD and agitation.

c) A client who had a hip arthroplasty 10 days ago and reports pain with ambulation requires atention, but their needs are not as urgent as those of the client with COPD and agitation.

d) A client who had a cerebrovascular accident 6 months ago and reports constipation requires attention, but their needs are not as urgent as those of the client with COPD and agitation.

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Correct Answer is B

Explanation

The nurse should include increased cardiac output as an expected eﬀect of digoxin when reinforcing teaching with the client. Digoxin is a positive inotropic medication that strengthens the force of contraction of the heart, resulting in increased cardiac output.

Option a, increased heart rate, is not an expected eﬀect of digoxin. Digoxin may actually decrease heart rate by exerting a negative chronotropic eﬀect.

Option c, decreased urinary output, is not an expected eﬀect of digoxin. In fact, digoxin does not directly aﬀect urinary output.

Option d, decreased potassium level, is not an expected eﬀect of digoxin. However, digoxin can increase the risk of hypokalemia, so it is important to monitor the client's potassium levels while on the medication.

A. "You should verify the identity of anyone who wants to remove your baby from the room." B. "You can leave your baby in your room while you walk in the hallway." C. "Your baby should have one identification band on either their right arm or right leg." D. "You can leave the unit with your baby as long as you notify the nurse."

Correct Answer is A

Explanation

The nurse should include the instruction to "verify the identity of anyone who wants to remove your baby from the room" in the teaching about security procedures. It is important for parents to be vigilant and ensure that only authorized personnel have access to their baby.

Option b is incorrect because it may not be safe for the parent to leave their baby unattended in their room while they walk in the hallway.

Option c is incorrect because newborns typically have two identification bands, one on their arm and one on their leg.

Option d is incorrect because parents should not leave the unit with their baby without proper authorization and discharge procedures.

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A nurse in a long-term care facility has received change-of-shift report about four clients. Which of the following clients should the nurse attend to first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reinforcing teaching with a client who has a new prescription for digoxin to treat heart failure. Which of the following should the nurse include as an expected eﬀect of this medication?

Correct Answer is B

Explanation

A nurse is reinforcing teaching with the parent of a newborn about security procedures. Which of the following instructions should the nurse include?

Correct Answer is A

Explanation

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