After an IV antibiotic is started, the nurse determines that the medication is not prescribed for the client and stops the infusion. Which action should the nurse implement next?

Document the event in the electronical health record.

Complete an incident report.

Inform the nurse on the next shift.

Notify the healthcare provider.

Answer and Explanation

The Correct Answer is B

A.   Document in the EHR: While documenting the event in the electronic health record is important, it's not sufficient to address the medication error. An incident report provides a more comprehensive and structured approach to documenting and investigating the event.
B.   When a medication error occurs, it's crucial to document the event through an incident report. This helps to identify the root cause of the error, prevent similar occurrences in the future, and ensure patient safety. An incident report should include a detailed description of the event, the actions taken, and any potential contributing factors.
C.   While informing the next shift is important for continuity of care, it's not the most immediate action needed to address the medication error. Completing an incident report is a higher priority.
D.   Notifying the healthcare provider is important, but it should be done in conjunction with completing an incident report. The incident report provides a detailed record of the event, which can be shared with the healthcare provider for further review and investigation.

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Correct Answer is C

Explanation

A. While practicing strength-building exercises for the arms, such as isometric exercises for the biceps and triceps, is beneficial for overall crutch use, it does not directly indicate proper crutch walking technique.
B. This choice is not correct for a three-point gait, especially in the case of a broken foot. In a three-point gait, the client should avoid bearing weight on the affected leg, as this gait is used to promote healing of a non-weight-bearing limb.
C. This behavior indicates a correct understanding of crutch walking. In the three-point gait, the client should bear weight on the crutches' handles and not on the armpits, which helps prevent nerve damage and provides better stability.
D. While it is important for safety to ensure that the rubber tips of the crutches are intact and not worn out, this behavior does not directly demonstrate the client’s understanding of the three-point gait technique.

A. Escort the client back to her room. B. Secure a bed alarm on the mattress. C. Orient the client to the surroundings. D. Raise the four side rails on the bed. E. Close the client's room door.

Correct Answer is ["A","B","C"]

Explanation

A. Escorting the client back to their room is a direct and immediate intervention that ensures the client is safely returned to a controlled environment. This action helps prevent further wandering and reduces the risk of falls or accidents.
B. Securing a bed alarm is a preventive measure that helps alert staff if the client attempts to get out of bed. This can be particularly useful for clients who are confused or at risk of wandering. The alarm provides an early warning to intervene before the client leaves the bed, thereby enhancing their safety and reducing the risk of falls.
C. Orienting the client helps them become more aware of their environment and can reduce confusion. Providing verbal cues and reassuring the client about their location and time can be beneficial in calming them and helping them to recognize where they are.
D. Raising all four side rails can be considered a form of restraint and is generally not recommended unless absolutely necessary and with appropriate justification. It can lead to increased risk of injury if the client tries to climb over the rails or if there is an emergency.
E. Closing the client’s room door can be a safety measure to prevent them from wandering out into other areas of the facility. However, it is crucial to ensure that the client is not left feeling isolated or trapped.

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After an IV antibiotic is started, the nurse determines that the medication is not prescribed for the client and stops the infusion. Which action should the nurse implement next?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is demonstrating three-point gait crutch walking to an older adult man who broke his foot while playing soccer with his grandchildren. Which behavior indicates that the client understands proper crutch walking?

Correct Answer is C

Explanation

The nurse finds a confused client wandering in the hallway during the night. Which actions should the nurse implement? Select all that apply.

Correct Answer is ["A","B","C"]

Explanation

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