A nurse is assessing the level of consciousness of a patient who sustained a head injury in a motor vehicle accident. The nurse notes that the patient appears drowsy most of the time but makes spontaneous movements. The nurse is able to wake the patient by gently shaking him and calling his name.

What level of consciousness would the nurse document?

Comatose

Awake and alert

Lethargic

Stuporous

Answer and Explanation

The Correct Answer is C

A. Comatose:

Coma refers to a state of deep unconsciousness where the individual is unresponsive to stimuli, including pain or external stimulation. In the scenario described, the patient is not comatose because they can be awakened by gentle shaking and calling their name.

B. Awake and alert:

This term describes a state of full alertness and responsiveness to the environment. The patient in the scenario is not fully awake and alert since they appear drowsy most of the time and require external stimuli to be awakened.

C. Lethargic:

Lethargy is characterized by drowsiness, reduced alertness, and a sluggish response to stimuli. In the scenario, the patient is described as drowsy most of the time but can be awakened by gentle shaking and calling their name. This aligns with the characteristics of lethargy.

D. Stuporous:

Stupor is a state of reduced responsiveness where the individual can be aroused only by vigorous or painful stimuli. The patient in the scenario does not fit the criteria for stupor as they can be awakened by gentle shaking and calling their name.

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Correct Answer is D

Explanation

A. The client attempted to climb over the side rails and fell:

This statement includes an interpretation of the client's actions. It's important to focus on factual information without making assumptions about the client's intentions or actions.

B. The client was restless and trying to get out of bed all evening:

Describing the client as restless and trying to get out of bed is a subjective interpretation of the client's behavior. Factual and objective observations are preferred when documenting incidents.

C. The presence of a bed alarm could have prevented the client from falling:

This statement includes an interpretation and a suggestion for prevention. While prevention strategies are important to consider, an incident report should primarily focus on describing what actually occurred rather than suggesting what could have prevented it.

D. The client was lying on the floor next to his bed:

This statement provides a clear and objective description of the situation without making assumptions or interpretations. It is important to document the actual events and the client's current condition.

Correct Answer is ["6"]

Explanation

To calculate the amount of ampicillin needed for one dose, we need to use a proportion. We can set up the proportion as follows:

150 mg / x mL = 125 mg / 5 mL

We can cross-multiply and solve for x:

150 * 5 = 125 * x

750 = 125 * x

x = 750 / 125

x = 6

Therefore, we need 6 mL of ampicillin for one dose

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is filling out an incident report after finding a client lying on the floor. Which of the following information should the nurse include?

Correct Answer is D

Explanation

Order: Ampicillin (Principen) 150 mg PO every 6 hours Available: Ampicillin (Principen) 125mg per 5 ml How many mL of ampicillin are needed for one dose? ( Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero. TYPE THE ANSWER ONLY, no label )

Correct Answer is ["6"]

Explanation

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