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A client who is at risk for pressure ulcers and has an albumin level of 4.2 g/dL

A client who has Type 1 diabetes and uses an insulin pump

A client who is receiving heparin and has an aPTT of 34 seconds

A client who has orthostatic hypotension and is receiving IV fluids

Answer and Explanation

The Correct Answer is A

Choice A Reason:
A client who is at risk for pressure ulcers and has an albumin level of 4.2 g/dL is correct. This client has multiple risk factors for developing pressure ulcers, including a low albumin level. An interdisciplinary conference would be beneficial to involve various healthcare professionals, such as wound care specialists, dietitians, and physical therapists, to develop a comprehensive plan of care to prevent and manage pressure ulcers.
Choice B Reason:
A client who has Type 1 diabetes and uses an insulin pump is incorrect. While managing Type 1 diabetes requires coordination among healthcare providers, the use of an insulin pump alone may not necessitate an interdisciplinary conference unless there are specific concerns or issues that require input from multiple disciplines.
Choice C Reason:
A client who is receiving heparin and has an aPTT of 34 seconds is incorrect. Monitoring heparin therapy and adjusting doses based on laboratory values such as activated partial thromboplastin time (aPTT) is typically within the purview of the nursing and medical team. An interdisciplinary conference may not be necessary unless there are complications or concerns that require input from other healthcare professionals.
Choice D Reason:
A client who has orthostatic hypotension and is receiving IV fluids is incorrect. Orthostatic hypotension and IV fluid management are often managed primarily by the nursing and medical team. While input from other disciplines may be valuable in certain cases, it may not warrant scheduling an interdisciplinary conference unless there are specific complexities or challenges that require input from multiple disciplines.

Nursing Test Bank

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Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

Choice A Reason:
Reinforcing facility protocols at the next staff meeting, is important for reminding all staff members of the importance of following protocols, but it may not address the immediate issue at hand.
Choice B Reason:
Discussing the issue with the AP is correct. When a charge nurse witnesses an assistive personnel (AP) failing to follow facility protocol, the first action should be to directly address the issue with the AP. This allows for immediate feedback and correction of behavior, helping to ensure that proper procedures are followed in the future.
Choice C Reason:
Alerting the infection control department, may be necessary if the violation poses a risk of infection transmission, but it may not be the first step. Directly addressing the issue with the AP allows for immediate correction and prevents potential harm.
Choice D Reason:
Notifying the unit manager about the incident, is also important, but addressing the issue with the AP directly is the immediate action needed to correct the behavior.

A. "I will be given contrast dye during this test." B. "I might have to wear a nose clip during this test." C. "I might have a tube inserted into my airway during this test." D. "I will run on a treadmill during this test."

Correct Answer is B

Explanation

Choice A Reason:
"I will be given contrast dye during this test." This statement is incorrect. Pulmonary function tests typically do not involve the use of contrast dye, as they focus on measuring lung function rather than visualizing anatomical structures.
Choice B Reason:
"I might have to wear a nose clip during this test." This statement is correct. Nose clips are commonly used during pulmonary function tests to ensure that air is only breathed in and out through the mouth, allowing for accurate measurement of lung function parameters.
Choice C Reason:
"I might have a tube inserted into my airway during this test." This statement is incorrect. While this statement reflects a potential misunderstanding or confusion about the procedure, it is not typically the case for a routine pulmonary function test. Invasive procedures such as bronchoscopy may involve inserting a tube into the airway, but it is not part of a standard pulmonary function test.
Choice D Reason:
"I will run on a treadmill during this test." This statement is incorrect. Pulmonary function tests do not involve physical exercise like running on a treadmill. Instead, they typically involve breathing maneuvers and measurements to assess lung function.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A charge nurse witnesses an assistive personnel (AP) failing to follow facility protocol when discarding contaminated linens. Which of the following actions should the nurse take first?

Correct Answer is B

Explanation

A nurse is assessing a client's comprehension of a pulmonary function test prior to the procedure. Which of the following client statements indicates to the nurse an understanding of the procedure?

Correct Answer is B

Explanation

A nurse is observing a newly licensed nurse prepare a medication from an ampule for a client's injection. For which of the following actions by the newly licensed nurse should the nurse intervene?

While auditing the medical records of clients currently on an oncology unit, the nurse manager finds that six of the 15 records lack documentation regarding advance directives. Which of the following is the priority action for the nurse to take?

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?

A charge nurse witnesses two nurses having a loud discussion at the nurses' station about not wanting to care for a client who has drug-resistant tuberculosis. Which of the following actions should the charge nurse take?

A charge nurse is reviewing information about HIPAA with a group of staff nurses. Which of the following statements by a staff nurse indicates understanding?

A client who is unconscious and has extensive internal injuries arrives via ambulance to the emergency department. The staff cannot reach the client's family. Which of the following permits the staff to proceed with emergency surgery?

A nurse is conducting an in-service on client advocacy with a group of newly licensed nurses. Which of the following scenarios should the nurse include as examples of client advocacy? (Select all that apply.)

The nurse observes that a client is experiencing melena. Which serum laboratory test should the nurse monitor in response to this finding?