It is most important to assign which client to a registered nurse rather than a practical nurse (PN)?
One hour after receiving hydromorphone prescribed for every 4 hours PRN use, a client reports severe pain.
Two hours after receiving morphine for acute pain, a client's vital signs are BP 112/60 mm Hg, pulse 88 beats/minute, and respirations 14 breaths/minute.
After ambulating, a postoperative client grimaces and reports incisional pain at a "9 on a ten-point scale".
The fentanyl transdermal patch for a client with chronic cancer pain needs to be replaced.
The Correct Answer is C
Choice A Reason: This client may need another dose of hydromorphone if the pain is not relieved by the previous one. A PN can administer this medication under the supervision of a RN and monitor the client's response.
Choice B Reason: This client's vital signs are within normal limits and indicate that the morphine is effective and not causing respiratory depression. A PN can assess and document the client's vital signs and pain level.
Choice C Reason: This is the correct answer because this client has acute and severe pain that may require immediate intervention and reassessment. An RN can evaluate the cause and severity of the pain, administer additional analgesics as prescribed, and implement nonpharmacological measures to relieve the pain.
Choice D Reason: This client has chronic and stable pain that is managed by a fentanyl patch. A PN can replace the patch according to the schedule and instructions provided by the RN.

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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A Reason: Choosing to send another nurse who is more receptive is not a good option, as it may create
resentment and conflict among the staff. The older nurse may feel discriminated against or excluded, and the other nurse may feel burdened or pressured. The nurse manager should try to engage and motivate the older nurse to attend the in-service session, as it is important for her professional development and patient safety.
Choice B Reason: Asking the nurse why she thinks there is no need for an in-service program about these emergencies may sound confrontational or accusatory and may put the nurse on the defensive. The nurse manager should avoid making assumptions or judgments about the nurse's attitude or beliefs, and instead try to understand her perspective and address any barriers or misconceptions.
Choice C Reason: Informing the older nurse that inservice is not optional and her scheduled attendance is mandatory may be true, but it may also sound authoritarian or coercive, and may undermine the nurse's autonomy or dignity. The nurse-manager should avoid using threats or ultimatums, and instead try to explain the rationale and benefits of the inservice session, and solicit the nurse's input or feedback.
Choice D Reason: Encouraging the nurse to share her concerns and discuss ways to prepare for such emergencies is the best option, as it shows respect and empathy for the nurse, and fosters a collaborative and supportive
relationship. The nurse-manager should use active listening and open-ended questions, and provide relevant information and resources to help the nurse overcome her fears or doubts, and enhance her confidence and competence.
Correct Answer is C
Explanation
Choice A Reason: Cautioning the nurse that one more tardiness will result in probational employment is not the best approach because it is too punitive and does not address the underlying cause of the tardiness. The nurse manager should first try to understand why the nurse is late and offer support or guidance if needed.
Choice B Reason: Offering to switch the nurse's shift assignments to afternoons or evenings is not the best approach because it may not solve the problem of tardiness and may create resentment among other staff members who have to adjust their schedules. The nurse manager should respect the nurse's preferences and availability but also hold the nurse accountable for fulfilling their responsibilities.
Choice C Reason: This is the best approach because it communicates clearly and respectfully what is expected of the nurse and why it is important for them to be punctual. The nurse manager should also provide feedback and recognition when the nurse improves their attendance.
Choice D reason: Having the nurse sign a copy of the hospital employee attendance policy is not the best approach because it may imply that the nurse is unaware or indifferent to the policy. The nurse manager should assume that the nurse knows and agrees with the policy, but may need some assistance or motivation to follow it.
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