A nurse in an acute care facility is preparing to transfer a client to a long-term care facility. Which of the following information should the nurse include in the hand-oﬀ report?

Time of the client's last bath

Eﬀectiveness of the last dose of pain medication

Number of family members who have visited

Frequency of previous vital sign measurement

Answer and Explanation

The Correct Answer is B

The correct answer is that the nurse should include information about the eﬀectiveness of the last dose of pain medication in the hand-oﬀ report when transferring a client to a long-term care facility. This information is important for the receiving facility to continue managing the client's pain eﬀectively.

Options a, c and d are not essential information to include in the hand-oﬀ report. The time of the client's last bath, the number of family members who have visited and the frequency of previous vital sign measurement are not critical for ensuring continuity of care during the transfer.

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Correct Answer is ["F"]

Explanation

f) Skin surrounding the stoma is reddened and appears irritated.

The information that requires intervention by the nurse is that the skin surrounding the stoma is reddened and appears irritated. This may indicate that the client is experiencing skin irritation or breakdown, which can lead to infection or other complications. The nurse should assess the skin and initiate appropriate interventions to prevent further skin damage.

Options a, b, c, d, e, and g do not necessarily require intervention by the nurse. A pink ileostomy stoma and moderate brown liquid stool drainage are normal findings. The client's refusal to look at the stoma or learn about stoma care may be concerning, but it is not an immediate priority for intervention. An intake of 2,200 mL over 24 hours and a urine output of 650 mL over 24 hours are within normal limits.

A. I will use a pumice stone to soften calluses on my feet. B. I will go barefoot just in the house. C. I can apply lotion to my feet if I avoid the area between my toes. D. I can use a heating pad when my feet are cold. E. I can use a heating pad when my feet are cold.

Correct Answer is C

Explanation

The correct answer is that the client can apply lotion to their feet if they avoid the area between their toes. Moisturizing the feet can help prevent dry skin and cracking, which are common problems for people with diabetes. However, it is important to avoid applying lotion between the toes, as this can create a moist environment that promotes the growth of fungus and bacteria¹.

Options a, b and d are not correct statements by the client that indicate an understanding of proper foot care for diabetes. Using a pumice stone to soften calluses on the feet, going barefoot just in the house and using a heating pad when feet are cold are not recommended practices for people with diabetes.

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A nurse in an acute care facility is preparing to transfer a client to a long-term care facility. Which of the following information should the nurse include in the hand-oﬀ report?

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Naxlex Comprehensive Predictor Exams

Correct Answer is ["F"]

Explanation

A nurse is providing instruction to a client who has diabetes mellitus about foot care. Which of the following statements by the client indicates an understanding of the teaching?

Correct Answer is C

Explanation

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