A nurse is caring for an older adult client who has a prescription for lorazepam 0.5 mg. Which of the following findings should the nurse report to the provider immediately?

Disorientation

Anorexia

Increased anxiety

Blurred vision

Answer and Explanation

The Correct Answer is A

A. Disorientation in an older adult after taking lorazepam could indicate an adverse reaction or an excessive sedative effect. It's crucial to report this immediately as it may signify an overdose or an adverse reaction to the medication. Older adults are more sensitive to the sedative effects of benzodiazepines, and disorientation can indicate potential serious side effects.

B. Anorexia (loss of appetite) is a possible side effect of lorazepam but is not typically considered an urgent or immediate concern unless it leads to severe dehydration or other complications.

C. Increased anxiety could potentially occur due to paradoxical reactions to benzodiazepines; however, it's not typically considered an urgent or immediate concern unless it's severe or distressing to the client.

D. Blurred vision is a common side effect of lorazepam and other benzodiazepines. While it should be monitored and reported, it might not be considered an urgent concern unless it's significantly affecting the client's ability to function or is accompanied by other severe symptoms.

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Correct Answer is A

Explanation

A. "I need to talk to you about unit expectations regarding timely completion of tasks."

This statement is non-confrontational and focuses on discussing the expectations of the unit regarding task completion. It allows the nurse to address the specific behavior (taking long breaks and making personal phone calls) without making accusatory or negative statements.

B. "You have been very inconsiderate of others by not completing your share of the work."

This statement may be perceived as accusatory and could escalate the conflict. It is important to communicate concerns without placing blame.

C. "Several staff members have commented that you don't do your fair share of the work."

This statement involves bringing in third-party opinions, which may not be the most direct and effective way to address the issue. It's better to address the concern directly with the individual involved.

D. "If you don't do your share of the work, I will have to inform the nurse manager."

Threatening to inform the nurse manager without first addressing the issue through communication can escalate the conflict. It's generally more productive to attempt to resolve conflicts through open and direct communication before involving higher authorities.

A. Assist a client to eat who has difficulty seeing the foods on the tray. B. Provide postmortem care for a client who has died. C. Observe a confused surgical client who has multiple tubes. D. Deliver a client's urine specimen to the laboratory.

Correct Answer is C

Explanation

A. Assist a client to eat who has difficulty seeing the foods on the tray.

Assisting a client with eating is a routine task that an AP can perform, especially when the client has difficulty with vision.

B. Provide postmortem care for a client who has died.

Postmortem care involves preparing the body of a deceased client. While it requires sensitivity, it is a task that can be appropriately delegated to assistive personnel.

C. Observe a confused surgical client who has multiple tubes.

Observing a confused client with multiple tubes requires a level of assessment and decision-making that goes beyond the scope of practice for an assistive personnel (AP). This task involves monitoring the client's condition, recognizing changes, and responding appropriately, which should be performed by a licensed nurse.

D. Deliver a client's urine specimen to the laboratory.

Transporting a urine specimen to the laboratory is a task that an assistive personnel can perform, as it does not involve interpretation or assessment of the specimen.

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A nurse is caring for an older adult client who has a prescription for lorazepam 0.5 mg. Which of the following findings should the nurse report to the provider immediately?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is working with two assistive personnel (AP). The nurse notes that one of the APs has been taking long breaks and making personal phone calls. Which of the following statements should the nurse make to resolve this conflict?

Correct Answer is A

Explanation

A nurse is caring for a group of clients on a medical surgical unit. Which of the following tasks is unsafe to assign to an assistive personnel (AP)?

Correct Answer is C

Explanation

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