A nurse is receiving change-of-shift report for a group of assigned clients. The nurse anticipates which of the following activities first in delivering client care using the nursing process?

Collect and organize client data.

Critically analyze client data to determine priorities.

Determine effectiveness of interventions.

Set client-centered, measurable and realistic goals.

Answer and Explanation

The Correct Answer is A

A. Collect and organize client data: The first step in the nursing process involves gathering and organizing data about the clients, which is essential for making informed decisions and planning care.

B. Critically analyze client data to determine priorities: Analysis of data and setting priorities come after the initial collection and organization of client data.

C. Determine effectiveness of interventions: Evaluating the effectiveness of interventions occurs after implementing the care plan and is not the first step in the process.

D. Set client-centered, measurable and realistic goals: Goal-setting follows the collection and analysis of data and is part of the planning phase in the nursing process.

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Correct Answer is A

Explanation

A. Specific characteristics of the medications: This is correct. The primary consideration for determining the medication schedule is the specific characteristics of each medication, including its pharmacokinetics, such as how often it should be administered and whether it needs to be taken with food or at certain times of the day.

B. Time at which the medication can be available from the pharmacy: While this may affect the timing of administration, it is not the primary factor. Medications should be scheduled based on their specific requirements for effectiveness and safety, regardless of pharmacy availability.

C. Institutional policies regarding routine medication administration times: Although institutional policies may provide guidelines for routine administration, they should be adjusted based on the specific needs of the medication and the client.

D. Schedule of administration that the client follows at home: While this may be relevant for maintaining continuity of care, the primary factor in determining the administration schedule should be the specific characteristics and requirements of the medications themselves.

A. Prior to administering each medication B. Before aspirating gastric contents C. When the flow of the medication by gravity slows D. After giving multiple medications E. After each medication

Correct Answer is ["A","D","E"]

Explanation

A. Prior to administering each medication: Instilling water before administering each medication helps ensure that the medication is properly delivered into the stomach and prevents the tube from clogging.

B. Before aspirating gastric contents: Instilling water before aspiration is not required and may not affect the aspiration process.

C. When the flow of the medication by gravity slows: This situation indicates a potential blockage or need for adjustment rather than a need for additional water.

D. After giving multiple medications: Instilling water after giving multiple medications helps to clear the tube of residual medication and prevents blockages.

E. After each medication: Instilling water after each medication ensures that the tube is flushed and all medication is delivered to the stomach.

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A nurse is receiving change-of-shift report for a group of assigned clients. The nurse anticipates which of the following activities first in delivering client care using the nursing process?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reviewing a client's admission record. The nurse notes that there are prescriptions for several medications. Which of the following factors should the nurse recognize is of primary consideration when determining the schedule of administration?

Correct Answer is A

Explanation

A nurse is administering several medications via a client's gastrostomy tube. At which of the following times should the nurse instill 15 to 30 mL of warm water? (Select all that apply.)

Correct Answer is ["A","D","E"]

Explanation

A nurse is preparing to instill ear drops to a 3-year-old child. Which of the following techniques should the nurse use?

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