A nurse is preparing to report a change in a client’s condition to another health care provider.
What should the nurse include in the report?
A summary of all the interventions performed since admission.
A description of how the nurse feels about the client’s situation.
A comparison of the client’s condition with other similar cases.
A statement of facts, changes, trends, and responses to treatment.
The Correct Answer is D
A statement of facts, changes, trends, and responses to treatment. This is the best way to report a change in a client’s condition to another health care provider because it provides clear, concise, and relevant information that can help with decision making and continuity of care.
Choice A is wrong because a summary of all the interventions performed since admission is too broad and may not reflect the current situation of the client.
Choice B is wrong because a description of how the nurse feels about the client’s situation is subjective and may not be helpful for the other health care provider. Choice C is wrong because a comparison of the client’s condition with other similar cases is not specific to the individual client and may not account for differences in factors such as age, comorbidities, or preferences.
Normal ranges for vital signs, laboratory values, and other parameters may vary depending on the source and the context, but some common examples are:.
• Temperature: 36.5°C to 37.5°C (97.7°F to 99.5°F).
• Pulse: 60 to 100 beats per minute.
• Respirations: 12 to 20 breaths per minute.
• Blood pressure: less than 120/80 mm Hg.
• Oxygen saturation: greater than 95%.
• Blood glucose: 4.0 to 7.8 mmol/L (72 to 140 mg/dL).
• Hemoglobin: 13.5 to 17.5 g/dL for males, 12.0 to 15.5 g/dL for females.
• White blood cell count: 4.0 to 11.0 x 10^9/L.
• Platelet count: 150 to 400 x 10^9/L.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","D"]
Explanation
The nurse should include factual information about what happened and notify the risk management department.These actions are part of the steps of reporting medication errorsand the good practice guide on recording, coding, reporting and assessment of medication errors.
Choice B is wrong because the nurse should not state opinions about who was responsible for the error.
This could be seen as biased, unprofessional or accusatory.
The nurse should focus on the facts and the causes of the error, not on blaming individuals.
Choice C is wrong because the nurse should not file the report in the client’s medical record.
This could violate the client’s privacy and confidentiality.
The report should be filed in a separate system that is accessible only to authorized personnel.
Choice E is wrong because the nurse should not discuss possible solutions to prevent future errors.
This could be premature, unrealistic or inappropriate.
The nurse should leave this task to the investigation team or the risk management department, who will analyse the incident and make recommendations based on evidence and best practice.
Correct Answer is ["A","B"]
Explanation
These are the only options that describe thesubjectiveandobjectivedata of the patient, which are part of theSOAPdocumentation method.SOAP stands forSubjective, Objective, Assessment, and Plan, and it is a way of recording patient data in a clear and consistent manner.
ChoiceCis wrong because wound culture results are not part of the assessment entry in SOAP documentation.They are part of the investigation results, which are usually documented in the objective section.
ChoiceDis wrong because risk for infection related to impaired skin integrity is a nursing diagnosis, not an assessment.Nursing diagnoses are usually documented in the plan section of SOAP documentation.
ChoiceEis wrong because applied moist heat compresses to the wound site is an intervention, not an assessment.Interventions are also documented in the plan section of SOAP documentation.
Normal ranges for vital signs are as follows:.
• Blood pressure: 90/60 mmHg to 120/80 mmHg.
• Pulse rate: 60 to 100 beats per minute.
• Respiratory rate: 12 to 20 breaths per minute.
• SpO2: 95% to 100%.
• Temperature: 36.5°C to 37.5°C.
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