A nurse on a surgical unit is preparing to transfer a client to a rehabilitation facility. Which of the following information should the nurse include in the change-of-shift report?

The time the client received his last dose of pain medication

The belief that the client has a difficult relationship with his son

The steps to follow when providing wound care

The client's preferred time for bathing

Answer and Explanation

The Correct Answer is A

- A) Knowing the time the client received his last dose of pain medication is crucial for continuity of care, ensuring that the client receives their next dose on time and pain management is consistent.
- B) Personal beliefs about the client's relationships are not relevant to the medical care and should remain confidential unless it directly impacts the care plan.
- C) While important, the detailed steps for wound care will be included in the client's care plan and are not typically communicated during a change-of-shift report unless there is a change or an issue.
- D) The client's preferred time for bathing is a part of personal care preferences and, while important for client comfort, is not critical information for a change-of-shift report unless it affects immediate care needs.

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Correct Answer is D

Explanation

a. “You should contact the provider about your wishes for your family member”: While involving the provider is essential, it doesn’t directly address the conflicting wishes between the partner and the family member.
b. “You should speak with the facility’s ethics committee about your concerns”: While acknowledging the need for ethical guidance, this option may not be the most immediate step.
c. “We’ll need to have the nursing supervisor review the client’s advance directives”: Although reviewing advance directives is crucial, it doesn’t directly address the current disagreement.
d. “As the health care surrogate, the client’s partner can make this decision”: This response recognizes the legal authority of the health care surrogate (partner) to make decisions on behalf of the unconscious client. It aligns with established principles.

A. Administer a sedative to the client B. Contact a family member to come and sit with the client C. Place the client in a wheelchair with a lap tray D. Keep the client in her room with the door closed

Correct Answer is B

Explanation

a. Administering a sedative should not be the first response, as it may not address the underlying cause of the behavior and may increase the risk of adverse effects.
b. Contacting a family member to provide support and comfort to the client can help alleviate agitation and may help redirect the client's behavior.
c. Placing the client in a wheelchair with a lap tray does not address the underlying cause of the behavior and may not be effective in managing agitation.
d. Keeping the client in her room with the door closed may isolate the client but does not address the underlying cause of the behavior or provide appropriate support.

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A nurse on a surgical unit is preparing to transfer a client to a rehabilitation facility. Which of the following information should the nurse include in the change-of-shift report?

Nursing Test Bank

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