A nurse is participating in interprofessional team meeting for a client. Which of the following information about the client should the nurse include?
The client’s vital signs are checked every 8 hr
The client has developed difficulty ambulating
The client has state-sponsored health insurance
The client's next dressing change is scheduled in 4 hr.
The Correct Answer is B
A) The client’s vital signs are checked every 8 hr: While vital signs are an important aspect of the client's health, this information is routine and doesn't provide new insights that would impact the overall plan of care during an interprofessional team meeting. It’s important to focus on changes in the client’s condition or specific concerns that require collaboration.
B) The client has developed difficulty ambulating: This is critical information to share during the interprofessional team meeting because it may require input from physical therapists, occupational therapists, or other specialists. Difficulty ambulating can indicate a need for reassessment of the client's mobility plan, and other team members need to be informed to develop appropriate interventions.
C) The client has state-sponsored health insurance: While the client’s insurance status is relevant for financial and discharge planning, it is not directly related to the clinical management or care coordination that would be discussed in an interprofessional team meeting. The focus should be on the client’s clinical condition and needs.
D) The client's next dressing change is scheduled in 4 hr: Although the dressing change is important for continuity of care, this is more of a task-related detail rather than critical clinical information that requires interprofessional discussion. The focus in a team meeting should be on the client's progress, challenges, and needs, not just routine care tasks.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A) *Restrict your daily fluid intake: Restricting fluid intake is not recommended for a client experiencing lightheadedness upon standing, especially when taking an ACE inhibitor. In fact, maintaining adequate hydration is important to help prevent hypotension, which could be exacerbated by fluid restriction. The lightheadedness may be due to orthostatic hypotension, which is a common side effect of ACE inhibitors.
B) *Take a daily potassium supplement: ACE inhibitors can increase potassium levels in the blood, potentially leading to hyperkalemia. For most clients, taking a potassium supplement is not necessary unless specified by the healthcare provider. In fact, many clients taking ACE inhibitors need to avoid excessive potassium intake, unless directed otherwise, to prevent dangerous potassium levels.
C) *Discontinue this medication if this occurs again: The nurse should not advise the client to discontinue the medication without consulting the healthcare provider. Lightheadedness upon standing is a common side effect of ACE inhibitors due to their blood pressure-lowering effects, and the healthcare provider should be notified if this becomes problematic. The decision to change or discontinue the medication should be made by the provider.
D) "Sit back down for a few minutes when this occurs": This is the most appropriate advice. Lightheadedness upon standing can be a sign of orthostatic hypotension, which is a known side effect of ACE inhibitors. The client should be instructed to sit down and rest when they experience these symptoms. If necessary, they should stand up slowly to allow their body to adjust to changes in position, which can help alleviate the lightheadedness.
Correct Answer is C
Explanation
A) Rubber duck:
A rubber duck may be a suitable toy for a 2-month-old infant during bath time, but it is not considered the most developmentally appropriate for this age. At 2 months, infants are beginning to focus their vision on objects but have limited ability to manipulate toys. Toys such as a rubber duck do not provide the most stimulating developmental experience for an infant at this age.
B) Nesting cups:
Nesting cups are not the most appropriate for a 2-month-old infant. At this stage of development, babies are still in the early stages of hand-eye coordination and grasping skills. Nesting cups are more suitable for older infants (around 6-9 months) who are beginning to explore stacking, nesting, and grasping objects with more precision.
C) Crib mobile:
A crib mobile is an excellent developmentally appropriate toy for a 2-month-old infant. At this age, infants are developing visual tracking skills and are attracted to high-contrast patterns or moving objects. A crib mobile offers visual stimulation and can help an infant focus their eyes on objects, encouraging visual tracking and early sensory development. It is also safe for use in the crib environment.
D) Plastic keys:
Plastic keys can be a good toy for older infants as they begin developing their grasping and mouthing skills, but a 2-month-old infant is not yet able to hold objects or bring them to their mouth with coordination. Toys like these would not offer much benefit in terms of developmental stimulation at this age.
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