A nurse is admitting a client who is 1 week postpartum and reports excessive vaginal bleeding. The nurse speaks a different language than the client. The client's partner and 10-year-old child are accompanying her. Which of the following actions should the nurse take to gather the client's admission data?

Ask a nursing student who speaks the same language as the client to translate.

Allow the client's partner to translate.

Request a female interpreter through the facility.

Have the client's child translate.

Answer and Explanation

The Correct Answer is C

A. Ask a nursing student who speaks the same language as the client to translate: This is not appropriate, as the nursing student may not be trained in medical terminology or confidentiality, which could lead to miscommunication and potential breaches of privacy.

B. Allow the client's partner to translate: While the partner may understand the language, this approach can create conflicts of interest, and they may not be able to convey the full medical context or sensitive information accurately.

C. Request a female interpreter through the facility: This is the best action. Using a trained, professional interpreter ensures that the communication is accurate and confidential, allowing the nurse to gather necessary admission data effectively while respecting the client's comfort and cultural needs.

D. Have the client's child translate: It is not appropriate to involve a child in medical discussions, as they may not fully understand the context or terminology and could feel overwhelmed by the responsibility.

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Correct Answer is C

Explanation

A) A history of being in prison: While a history of incarceration can be associated with a higher risk for violence, it is not as strong a predictor as previous violent behavior. Many individuals may have been incarcerated for non-violent offenses.

B) Male gender: Although males are statistically more likely to engage in violent behavior, gender alone is not the best predictor of future violence. It does not account for individual history or behavior.

C) Previous violent behavior: This is the best predictor of future violence. Individuals who have exhibited violent behavior in the past are at a significantly increased risk of future violence. This history can be a critical indicator of potential risk.

D) Experiencing delusions: While delusions can contribute to violent behavior in some cases, they are not a reliable predictor of future violence. Not all individuals experiencing delusions will act violently, and many other factors must be considered.

A. Review the skill level and qualifications of each AP. B. Communicate appropriate tasks to the APs with specific expectations. C. Monitor progress of task completion with each AP. D. Evaluate the APs' performance of each task.

Correct Answer is A,B,C,D

Explanation

To delegate tasks to assistive personnel (APs) effectively, the nurse should follow this sequence:

A. Review the skill level and qualifications of each AP.
B. Communicate appropriate tasks to the APs with specific expectations.
C. Monitor progress of task completion with each AP.
D. Evaluate the APs' performance of each task.

This order ensures that the nurse first assesses the abilities of the APs, then clearly communicates tasks, monitors their progress, and finally evaluates their performance.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A charge nurse is teaching new staff members about factors that increase a client's risk to become violent. Which of the following risk factors should the nurse include as the best predictor of future violence?

Correct Answer is C

Explanation

A nurse has identified tasks to delegate to a group of assistive personnel (AP) after receiving change-of-shift report. Identify the sequence of steps the nurse should follow when delegating tasks to the APs. (Move the steps, placing them in the selected order of performance. Use all the steps.)

Correct Answer is A,B,C,D

Explanation

A nurse manager on an interprofessional team is creating a disaster plan. The nurse should include in the plan that which of the following actions is the responsibility of the unit nurse during a disaster?

A nurse is preparing to administer levothyroxine 50 micrograms to a client. Available is levothyroxine 0.025 mg/tablet. How many tablets should the nurse administer per dose? (Round to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

A nurse is caring for a child who has cystic fibrosis and requires postural drainage. Which of the following actions should the nurse take?

A nurse is receiving change-of-shift report for a group of clients. Which of the following clients should the nurse plan to assess first?

A nurse is caring for a client who has systemic lupus erythematosus. Which of the following client findings should the nurse expect?

A nurse is caring for a client who has cancer and is terminally ill. The client reports feeling depressed. Which of the following statements should the nurse make?

A nurse is building a therapeutic relationship with a newly admitted client. Which of the following actions should the nurse plan to take during the orientation phase of the relationship?

A nurse is providing teaching to a client who has diabetes mellitus about the glycosylated hemoglobin blood test. Which of the following statements by the client indicates an understanding of this test?