A nurse is accessing computerized data about a client recently transferred to a step-down unit. Which of the following forms should provide the nurse with the most comprehensive client information?
Medication administration record
Standardized care plan
180 record
Client care Kardex
The Correct Answer is D
A. Medication administration record:
The medication administration record (MAR) primarily contains information related to medications, dosages, and administration times. While it provides important details about medications, it may not offer a comprehensive overview of the client's overall care.
B. Standardized care plan:
A standardized care plan typically outlines general care guidelines and interventions for specific conditions. It may provide a structured approach to care but might lack the individualized details needed for a specific client.
C. 180 record:
The term "180 record" does not commonly refer to a standard nursing documentation form. It might be a local or facility-specific term. Without additional information, it's unclear what type of information this form would contain.
D. Client care Kardex:
This is the correct answer. The Client care Kardex, also known as the patient care summary or Kardex, is a document that consolidates key information about a client's care, including diagnoses, treatments, procedures, and other relevant details. It provides a snapshot of the client's current status and facilitates communication among healthcare providers.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Engage the client in a repetitive activity as a distraction:
This is the correct answer. Redirecting the client's focus to a repetitive and calming activity can help distract them from the source of agitation and potentially de-escalate the situation.
B. Place the client in a seclusion room:
Seclusion should only be used in situations where it is absolutely necessary for the safety of the client or others. Placing a client with dementia in seclusion is not the first choice and should be avoided if possible.
C. Apply wrist restraints to the client:
Restraints should be a last resort and used only when there is an imminent risk of harm to the client or others. Restraints can escalate agitation and should not be the initial response.
D. Administer PRN haloperidol IM to the client:
The use of medication should be considered later in the escalation process and after other non-pharmacological interventions have been attempted. It is not the first intervention, especially when there are non-pharmacological options available.
Correct Answer is ["0.2"]
Explanation
To give a client with rheumatoid arthritis a subcutaneous dose of methotrexate 7.5 mg, the nurse needs to calculate the correct volume of the drug solution.
The drug solution has a concentration of 15 mg/0.4 mL, which means that 0.4 mL of the solution contains 15 mg of methotrexate. To find the volume of the solution that contains 7.5 mg of methotrexate, the nurse can use a proportion:
- 15 mg/0.4 mL = 7.5 mg/x mL
Cross-multiplying and solving for x gives:
- x = (0.4 mL x 7.5 mg) / 15 mg
- x = 0.2 mL
Therefore, the nurse should administer 0.2 mL of the drug solution to deliver 7.5 mg of methotrexate subcutaneously.
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