A nurse is preparing to administer a controlled substance to a client for pain management.

Which of the following actions should the nurse take?

Verify the count total of the controlled substance after removing the amount needed.

Place the wasted portion of the controlled substance in the sharps container.

Report any discrepancy in the count total of the controlled substance after administration.

Ask a second nurse to record her signature when wasting any unused portion of the controlled substance.

Answer and Explanation

The Correct Answer is D

Ask a second nurse to record her signature when wasting any unused portion of the controlled substance.
This is because if a controlled substance is wasted, this waste must be witnessed by and documented by the wasting nurse and another nurse.
Choice A is wrong because the count total of the controlled substance should be verified before removing the amount needed, not after.
Choice B is wrong because the wasted portion of the controlled substance should not be placed in the sharps container.
It should be disposed of according to facility/agency policy.
Choice C is wrong because any discrepancy in the count total of the controlled substance should be reported immediately, not after administration 1.

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Correct Answer is C

Explanation

When caring for a client who has wrist restraints after an episode of violent behavior, the nurse should remove one restraint at a time.
This allows the nurse to assess the client’s behavior and response to having one arm free while still maintaining some level of control and safety.
Choice A is wrong because tying the restraints to the side rail can be dangerous as it can cause injury to the client if they move suddenly.
Choice B is wrong because removing the restraints every 3 hours is not a specific guideline and may vary depending on the facility’s policy and the client’s condition.
Choice D is wrong because securing restraints with a square knot can make it difficult to quickly release the restraints in an emergency.

A. "I will keep my legs crossed while sitting." B. "I will perform leg exercises once every 4 hours while I am awake." C. "I should limit the time that I spend sitting in a chair." D. "I should massage my legs when they hurt.".

Correct Answer is C

Explanation

“I should limit the time that I spend sitting in a chair.” This is important because sitting for long periods of time can increase the risk of thrombus formation.
Choice A is wrong because crossing the legs while sitting can impede blood flow and increase the risk of thrombus formation.
Choice B is wrong because leg exercises should be performed more frequently than once every 4 hours while awake.
Choice D is wrong because massaging the legs when they hurt can dislodge a thrombus and cause it to travel to other parts of the body.

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A nurse is preparing to administer a controlled substance to a client for pain management. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

When caring for a client who has wrist restraints after an episode of violent behavior, which of the following actions should the nurse take?

Correct Answer is C

Explanation

A nurse is providing teaching to a client who is at risk for thrombus formation. Which of the following statements made by the client indicates an understanding of the teaching?

Correct Answer is C

Explanation

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A nurse is preparing to administer a controlled substance to a client for pain management.

Which of the following actions should the nurse take?