The smell of cigarette smoke is coming from a client's bathroom. Which action should the nurse implement first?
Document the occurrence in the client's record.
Obtain a prescription for a nicotine patch during hospitalization.
Educate the client about the hospital smoking policy.
Notify the charge nurse about the situation immediately.
The Correct Answer is D
Choice A Reason: This is not the first action because it does not address the safety risk of smoking in the hospital. The nurse should document the occurrence after taking appropriate measures to prevent fire and injury.
Choice B Reason: This is not the first action because it does not stop the client from smoking in the bathroom. The nurse should obtain a prescription for a nicotine patch if the client agrees to quit smoking, but this is not a priority at this time.
Choice C Reason: This is not the first action because it does not ensure that the client will comply with the hospital smoking policy. The nurse should educate the client about the health hazards of smoking and the hospital rules, but this can be done later.
Choice D Reason: This is the best action because it alerts the authority figure who can intervene and enforce the hospital smoking policy. The nurse should notify the charge nurse as soon as possible to prevent fire and injury.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A) This client has a mild fever, which may indicate an infection or inflammation. This is a potential complication of enteral feedings, but it is not the most urgent situation. The nurse should monitor the client's vital signs, assess the feeding tube site, and notify the provider if the fever persists or worsens.
B) This client has signs of uremic encephalopathy, which is a life-threatening condition caused by the accumulation of toxins in the brain due to impaired renal function. The nurse should intervene immediately to prevent further
neurological damage and possible coma or death. The nurse should assess the client's level of consciousness, check the blood pressure and urine output, and prepare to administer dialysis or other treatments as ordered by the provider.
C) This client has heat stroke, which is a serious condition that can lead to dehydration, electrolyte imbalance, and organ damage. However, the client is receiving a normal saline IV fluid bolus, which is an appropriate intervention to restore fluid volume and correct sodium levels. The nurse should continue to monitor the client's vital signs, skin
temperature, and urine output, and watch for signs of fluid overload or cerebral edema.
D) This client has hyperemesis gravidarum, which is a severe form of nausea and vomiting during pregnancy that can lead to dehydration, malnutrition, and electrolyte imbalance. However, the client is receiving an infusion of Ringer's Lactate, which is an isotonic solution that can replenish fluid and electrolyte losses. The nurse should continue to monitor the client's vital signs, weight, and intake and output, and administer antiemetics or other medications as ordered by the provider.
Correct Answer is A
Explanation
Choice A Reason: This role is responsible for coordinating the continuum of care for clients with complex health needs, such as head injury. The nurse case manager collaborates with the interdisciplinary team, the client, and the family to plan, implement, and evaluate the client's care from admission to discharge.
Choice B Reason: This role is responsible for providing primary and specialty care to adults, such as diagnosing and treating acute and chronic conditions, prescribing medications, and ordering tests. The adult nurse practitioner may be involved in the client's care, but not in coordinating it.
Choice C Reason: This role is responsible for managing the daily operations of the neurology unit, such as staffing, budgeting, quality improvement, and staff development. The neurology unit supervisor may oversee the client's care while on the unit, but not throughout the continuum of care.
Choice D Reason: This role is responsible for identifying and preventing potential risks and liabilities in the healthcare setting, such as errors, injuries, infections, or lawsuits. The risk management nurse may monitor the client's care for quality and safety issues, but not for coordination.
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