a
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
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
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A Reason:
Completing an incident report is inappropriate. While completing an incident report is important for documenting any errors or deviations from the standard of care, it should not be the first action taken. Assessing the client's condition takes precedence to ensure their immediate safety and well-being.
Choice B Reason:
Notifying the provider is inappropriate. Notifying the provider may be necessary, but it should not be the first action taken. Initially, the nurse should assess the client's condition to determine if any adverse effects have occurred as a result of the additional medication dose.
Choice C Reason:
Informing the nursing supervisor is inappropriate. Informing the nursing supervisor may be appropriate, especially if further actions or investigations are needed. However, the immediate priority is to assess the client's condition to ensure their safety.
Choice D Reason:
Observing the client's condition is appropriate. The nurse should first assess the client's condition to determine if any adverse effects have occurred due to the additional medication dose. This assessment helps identify any immediate concerns that require intervention. Based on the client's condition, further actions such as notifying the provider or completing an incident report may be warranted. However, observing the client's condition is the initial and most immediate action to take.
Correct Answer is C
Explanation
Choice A Reason:
Obtaining client intake and output instead of delegating the task to an assistive personnel, may or may not indicate effective time management. It depends on the specific circumstances and urgency of other tasks. Delegating appropriate tasks to assistive personnel can be a component of effective time management when done judiciously.
Choice B Reason:
Documenting medications administered throughout the shift at the end of the day, is not indicative of effective time management. Delaying documentation until the end of the day can lead to inaccuracies, omissions, and potential safety concerns. Timely documentation is essential for maintaining accurate and up-to-date records.
Choice C Reason:
Reviewing a client's medical record before performing a prescribed dressing change is correct. Effective time management involves prioritizing tasks, organizing workflow efficiently, and completing tasks in a timely manner while maintaining quality of care. Option C demonstrates effective time management because reviewing a client's medical record before performing a prescribed dressing change ensures that the nurse is prepared and has all necessary information to perform the task accurately and safely. This action indicates proactive planning and organization, which are key aspects of effective time management.
Choice D Reason:
Skipping lunch to catch up on client documentation, is not indicative of effective time management. Skipping meals can negatively impact the nurse's well-being and ability to provide safe and effective care. Effective time management involves finding a balance between completing tasks efficiently and taking breaks to maintain personal health and well-being.
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