A nurse is collecting data from a client who reports feeling stress. Which of the following should the nurse identify as an external stressor?

Recurring urinary tract infections

A recent move to a new city

Lack of nutritional knowledge

Report of feeling depressed

Answer and Explanation

The Correct Answer is B

A.   Incorrect. Recurring urinary tract infections are related to health and hygiene and are not typically considered external stressors.
B.   Correct. A recent move to a new city is an external stressor because it is an environmental change that can lead to feelings of stress and adjustment.
C.   Incorrect. Lack of nutritional knowledge is an internal stressor related to the client's knowledge and awareness, not an external factor.
D.   Incorrect. Feeling depressed is an internal emotional state and is not an external stressor.

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Correct Answer is A

Explanation

Chemotherapy treatments. Varicella immunization is a live vaccine that can cause mild infection in some people. Chemotherapy treatments can weaken the immune system and make it harder to fight off infections. Therefore, people who are receiving chemotherapy should not get live vaccines. The other options are not contraindications for varicella immunization.

A. An approximate amount of urine was recorded after the urine leaked from the client's catheter bag. B. A client received an 0900 daily medication at 1000. C. A client who has an infection refused the evening meal. D. A client received the first dose of an antibiotic 1 hr before the collection of blood for culture and sensitivity testing. E. A client fell when ambulating to the bathroom alone.

Correct Answer is ["A","B","E"]

Explanation

The nurse should write an incident report for the following events:
1. An approximate amount of urine was recorded after the urine leaked from the client's catheter bag. This indicates a potential issue with the catheter or its proper functioning, which needs to be documented and addressed.
2. A client received an 0900 daily medication at 1000. This is a medication administration error as the medication was given later than the prescribed time. Medication errors should be reported and documented to ensure proper follow-up and prevent future occurrences.
3. A client fell when ambulating to the bathroom alone. Falls are considered significant incidents and should always be documented and reported to ensure appropriate evaluation, intervention, and prevention of future falls.
The following events do not require an incident report:
A client who has an infection refused the evening meal. While it is important to document a client's refusal of meals, it does not typically warrant an incident report unless there are specific concerns related to the client's health or safety.

A client received the first dose of an antibiotic 1 hr before the collection of blood for culture and sensitivity testing. This may not require an incident report unless there are specific

circumstances or contraindications related to the timing of the antibiotic administration and blood collection, which need to be documented and reviewed.

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A nurse is collecting data from a client who reports feeling stress. Which of the following should the nurse identify as an external stressor?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reviewing the medical record for a child who is scheduled to receive a varicella immunization. Which of the following findings in the client's record should the nurse recognize as a contraindication?

Correct Answer is A

Explanation

A nurse is reviewing the medical records of five clients. For which of the following events should the nurse write an incident report? (Select all that apply.)

Correct Answer is ["A","B","E"]

Explanation

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