The practical nurse (PN) is preparing to transfer an unresponsive client from the bed to a stretcher. Which client data is most important for the PN to obtain before beginning the transfer?

Skin turgor.

Body weight.

Temperature.

Blood pressure.

Answer and Explanation

The Correct Answer is D

A. Skin turgor is important for assessing hydration status, but it is not the most critical factor when preparing for a safe transfer. For an unresponsive client, ensuring stable hemodynamic conditions is more urgent. Blood pressure provides essential information about the client’s circulatory status, which is crucial for assessing the risks associated with the transfer.
B. Body weight is generally used for dosing medications or assessing nutritional status and is not immediately relevant for ensuring a safe transfer of an unresponsive client. Although body weight might be useful in planning the transfer logistics, it does not impact immediate safety concerns.
C. Temperature can indicate infection or other issues but does not directly affect the immediate safety of the transfer process. While monitoring temperature is part of overall care, it is not the most pressing concern during the transfer.
D. Blood pressure is essential to check before the transfer because it reflects the client’s cardiovascular stability. Low or unstable blood pressure might increase the risk of complications during the transfer, such as a sudden drop in blood pressure that could lead to a fall or injury.

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Correct Answer is A

Explanation

A. Intense cravings are a common symptom of cocaine withdrawal. Individuals withdrawing from cocaine often experience strong urges to use the drug again, as their bodies adjust to the absence of the substance.
B. Hyperactivity is more characteristic of cocaine intoxication rather than withdrawal. During withdrawal, individuals are more likely to experience fatigue and lethargy.
C. Being talkative is associated with cocaine use, not withdrawal. Cocaine stimulates the central nervous system, leading to increased talkativeness during intoxication, but withdrawal often involves a reduction in energy and social engagement.
D. Elation is a symptom of cocaine intoxication. During withdrawal, individuals are more likely to feel dysphoric, anxious, or depressed rather than elated.

A. Notify the unit charge nurse of the finding. B. Administer humidified oxygen per nasal cannula. C. Ensure that the drainage device is compressed. D. Obtain a cup of ice chips for the client.

Correct Answer is A

Explanation

A. Hoarseness in the voice following a thyroidectomy can be a sign of vocal cord damage or laryngeal nerve injury, which are potentially serious complications. The appropriate action is to notify the unit charge nurse to escalate the finding for further assessment by a physician or advanced practice provider.
B. Administering humidified oxygen does not specifically address the issue of hoarseness. While humidified oxygen might be beneficial for general respiratory comfort, it is not a targeted intervention for potential vocal cord damage.
C. Ensuring that the drainage device is compressed is important for managing surgical wounds but does not address or diagnose vocal cord issues. Hoarseness after thyroid surgery is more indicative of a potential complication rather than a drainage issue.
D. Obtaining ice chips does not address the underlying cause of the hoarseness and may not provide significant relief. The priority is to identify potential complications rather than offering symptomatic relief.

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The practical nurse (PN) is preparing to transfer an unresponsive client from the bed to a stretcher. Which client data is most important for the PN to obtain before beginning the transfer?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The practical nurse (PN) is caring for a client whose urine drug screen is positive for cocaine. Which behavior should the PN document as evidence of cocaine withdrawal?

Correct Answer is A

Explanation

While caring for a client one day following a thyroidectomy, the practical nurse (PN) notes that the client's voice is hoarse. Which action should the PN take?

Correct Answer is A

Explanation

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A client is using an incentive spirometer on the first postoperative day after an inguinal herniorrhaphy. The practical nurse (PN) should reteach the proper use of the spirometer when the client demonstrates which action?

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