A nurse is preparing to administer an antibiotic to a client who has pneumonia. After confirming that the client's assigned identification number matches the medication administration record, the nurse should use which of the following as a second identifier?

Home telephone number

Medical diagnosis

Date of admission

Facility room number

Answer and Explanation

The Correct Answer is A

Rationale:

A. Home telephone number: A home telephone number is an acceptable second client identifier under The Joint Commission's guidelines, as it is specific to the individual and can help prevent medication errors when used alongside another unique identifier.

B. Medical diagnosis: A medical diagnosis is not a unique identifier and may be shared by multiple clients in the same facility. It does not provide adequate confirmation of a client's individual identity.

C. Date of admission: Admission dates are not unique and may be the same for several clients. This information is insufficient as a reliable identifier for ensuring safe medication administration.

D. Facility room number: Room numbers can change during hospitalization and are not considered safe identifiers. Clients may be transferred, making room number an unreliable and non-permanent method of identification.

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Correct Answer is A

Explanation

Rationale:

A. "I will place a night light in the hallway near the bathroom.": Installing night lights in commonly used paths, such as the hallway to the bathroom, helps prevent falls by improving visibility during nighttime trips, which is especially important for older adults with limited vision or balance.

B. "I will use a standard height toilet seat.": Standard height toilet seats can make sitting and standing more difficult for older adults. Raised toilet seats are safer and reduce the risk of falls by minimizing the effort required to use the toilet.

C. "I will set my water heater to 145 degrees Fahrenheit.": This temperature is too high and increases the risk of scald injuries. Water heaters should be set to no more than 120°F to protect older adults from accidental burns, as their skin is often thinner and more sensitive.

D. "I will cover extension cords with throw rugs.": Covering cords with rugs creates a tripping hazard. Extension cords should be secured against walls or removed altogether to reduce fall risk, especially in homes with elderly residents.

A. Encourage the client to increase fluid intake B. Obtain the client's weight. C. Palpate the access site for a thrill. D. Auscultate the access site for a bruit.

Correct Answer is B

Explanation

Rationale:

A. Encourage the client to increase fluid intake: Clients undergoing peritoneal dialysis often have fluid restrictions based on residual renal function and ultrafiltration goals. Increasing fluid intake without specific provider guidance may lead to fluid overload.

B. Obtain the client's weight: Daily weight measurement is essential in peritoneal dialysis to assess fluid removal effectiveness and detect signs of fluid retention or dehydration. Weight changes help guide dialysis fluid volume and concentration adjustments.

C. Palpate the access site for a thrill: A thrill is assessed in clients with an arteriovenous (AV) fistula or graft used for hemodialysis, not peritoneal dialysis. Peritoneal dialysis uses a catheter placed in the abdominal cavity, which does not produce a thrill.

D. Auscultate the access site for a bruit: A bruit is associated with blood flow through an AV fistula or graft used in hemodialysis. In peritoneal dialysis, the access is a soft catheter, and auscultation for a bruit is not applicable or expected.

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A nurse is preparing to administer an antibiotic to a client who has pneumonia. After confirming that the client's assigned identification number matches the medication administration record, the nurse should use which of the following as a second identifier?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

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Correct Answer is B

Explanation

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