A nurse received change-of-shift report at 0700 for four clients. Which of the following actions should the nurse perform first?

Restart an infiltrated IV for a client whose IV antibiotic is scheduled for 0900.

Obtain a breakfast tray for a client who received a morning dose of insulin aspart.

Administer pain medication to a client who has rheumatoid arthritis and received the last dose at 0400.

Replace a client's enteral nutrition feeding solution that has been hanging for 24 hr.

Answer and Explanation

The Correct Answer is B

Rationale:
A. Restarting an infiltrated IV is important for antibiotic therapy, but the dose is not due until 0900, so it is not the immediate priority.
B. Insulin aspart is a rapid-acting insulin that peaks quickly. The client must eat promptly to prevent hypoglycemia, making this the highest priority.
C. Administering pain medication for rheumatoid arthritis is necessary, but this is not life-threatening and can be addressed after preventing hypoglycemia.
D. Replacing an enteral feeding solution that has been hanging for 24 hr is important for infection control, but it is not as urgent as preventing acute hypoglycemia.

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Correct Answer is B

Explanation

Rationale:
A. Choosing an infant safety system should not occur until the committee first understands the required standards and regulations.
B. The first step in quality control is to identify industry standards or benchmarks. This ensures the facility’s practices align with established guidelines for infant safety.
C. Establishing measurement criteria comes after standards are identified, so performance can be measured against them.
D. Evaluation of a selected system is one of the final steps, after standards are identified, a system is chosen, and criteria are established.

A. Social worker B. Pharmacist C. Child protective services D. Respiratory therapist

Correct Answer is A

Explanation

Rationale:
A. A social worker can assist the family in obtaining financial resources, insurance coverage, or community programs to help cover the cost of the nebulizer, making this the correct referral.
B. A pharmacist can provide medication education and possible cost-saving alternatives for prescriptions but cannot arrange funding or equipment access.
C. Child protective services is not appropriate, as the parent is seeking help and there is no indication of neglect or abuse.
D. A respiratory therapist can teach proper use of the nebulizer and asthma management techniques but cannot address the family’s financial barrier to obtaining the equipment.

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A nurse received change-of-shift report at 0700 for four clients. Which of the following actions should the nurse perform first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is A

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