A nurse is preparing to transfer a client from the ICU to the medical floor. The client was recently weaned from mechanical ventilation following a pneumonectomy. Which of the following information should the nurse include in the change-of-shift report?
The frequency in which the client presses the call button
The client's most recent ventilator settings
The time of the client's last dose of pain medication
The last time the provider evaluated the client
The Correct Answer is C
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Out of the provided options, the most important information for the nurse to include in the change-of-shift report is:
c. The time of the client's last dose of pain medication
Here's why:
- a. The frequency in which the client presses the call button: While this could be relevant to assess the client's overall well-being or potential anxiety, it's not as crucial as pain management in this specific scenario.
- b. The client's most recent ventilator settings: Since the client is already weaned from ventilation, this information is no longer pertinent.
- d. The last time the provider evaluated the client: While provider updates are important, especially after major procedures like a pneumonectomy, knowing the exact timing isn't as critical as pain management, especially considering the potential for increased pain after surgery and weaning from ventilation.
- c. The time of the client's last dose of pain medication: Pain management is paramount after a pneumonectomy. Knowing the timing of the last dose allows the receiving nurse to assess the need for further medication and potential for breakthrough pain management. Additionally, it provides a baseline for monitoring pain trends and potential complications related to pain, such as decreased mobility or respiratory compromise.
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Therefore, while all the information listed could be relevant at some point, knowing the time of the last pain medication dose is the most crucial for immediate patient care and should be prioritized in the change-of-shift report for a post-pneumonectomy client transitioning from ICU to the medical floor.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice C rationale:
The client's speech, "Tie a bow. Row the boat. Now I know. Whoa! I see you, yo," is an example of word salad. Word salad is a disorganized mixture of words and phrases that lack coherent meaning and logical connection. It is often observed in severe cases of schizophrenia or other mental health disorders and indicates a significant impairment in thought process and communication. In word salad, words and phrases are randomly juxtaposed, making it difficult to understand the intended message.
Choice A rationale:
Neologisms are newly coined words or phrases that have meaning only to the individual using them. Neologisms are often created by individuals with mental disorders and might not make sense to others. In the given speech, the words and phrases, although disorganized, are not newly coined or invented terms, so neologisms do not apply here. **
Correct Answer is A
Explanation
Hospice care includes bereavement support for the family for up to a year after the client's death.
- B is incorrect because the hospice nurse does not administer pain medication, but rather teaches the family how to manage the client's pain at home.
- C is incorrect because respite care is one of the services that hospice provides to allow the family to take a break from caregiving.
- D is incorrect because hospice care does not aim to prolong life, but rather to provide comfort and quality of life for the client and the family.
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