A nurse is transferring a client to another unit. Which of the following statements should the nurse include in the transfer report?
"He appears anxious about the transfer."
"He is allergic to sulfa."
"His partner has been visiting."
"He is voiding adequately."
The Correct Answer is B
Choice A Reason:
"He appears anxious about the transfer."While this might be relevant in certain contexts, it is subjective and less critical compared to other clinical information. The transfer report should prioritize objective data that directly impacts the client’s care.
Choice B Reason:
"He is allergic to sulfa." Allergies are crucial information that must be communicated during any transfer. This ensures that the receiving healthcare team is aware and can avoid administering medications that could cause an allergic reaction. This is important information to include in the transfer report.
Choice C Reason:
"His partner has been visiting." While it may be helpful to know about the client’s support system, this information is not as critical as details about the client's health status, medications, or allergies.
Choice D Reason:
"He is voiding adequately." Voiding patterns can be relevant, particularly if there have been recent issues with urinary function or if the client is being monitored for urinary output. However, unless there is a specific reason this is critical to ongoing care, it may not be the most essential information to include.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A Reason:
While documenting the refusal is important for accurate record-keeping and to ensure communication among the healthcare team, addressing the client's immediate concerns and attempting to resolve the issue of medication refusal should take precedence before documenting.
Choice B Reason:
Returning the medication is a procedural step but is not the immediate action needed when a client refuses medication due to adverse effects. First, it's important to address the client's concerns and discuss the potential consequences of refusal.
When a client refuses medication due to experiencing adverse effects, the initial action for the nurse to take is:
Choice C Reason:
Inform the client of the potential consequences of their refusal is correct. It's essential to engage in a conversation with the client to understand their concerns and educate them about the potential consequences of not taking their antihypertensive medication. The nurse should discuss the risks associated with untreated high blood pressure to ensure the client is informed about the importance of the prescribed medication.
Choice D Reason:
Notifying the provider is important, but it is generally done after the nurse has attempted to address the client’s concerns and informed them of the consequences. The provider should be informed if the refusal persists or if the nurse believes the situation requires further medical intervention.
Correct Answer is D
Explanation
Choice A Reason:
"I will rinse the contaminants from a bedpan with hot water." Is incorrect. Rinsing contaminants with hot water might not be sufficient for proper disinfection and could potentially contribute to the spread of infection. Proper disinfection methods involve using appropriate cleaning agents or disinfectants.
Choice B Reason:
"I will double-bag a client's linens each day." Is incorrect. While containing soiled linens is important, double-bagging might not necessarily be a standard practice for managing linens unless there's a specific protocol or contamination issue. It might not be directly related to infection control principles.
Choice C Reason:
"I will wear sterile gloves when bathing a client who is incontinent." Is incorrect. Wearing sterile gloves for routine bathing of an incontinent client is not typically necessary. Using clean gloves or standard precautions would generally be appropriate unless there's a specific medical procedure requiring sterile technique.
Choice D Reason:
"I will use disinfectant to clean the blood pressure cuff after use on a client." Is correct. Using a disinfectant to clean equipment, especially after use on a client, is a key infec
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