When preparing to B) Withhold the medication until the dosage can be
administer a prescribed confirmed.
medication to a homeless
client at a community
psychiatric clinic. The
client tells the nurse that
the usual dosage taken is
different from the dose
the nurse is giving. Which
action should the nurse
take?
A) Inform the client that
he may refuse the
medication and
document whether or not
the client takes it.
B) Withhold the
medication until the
dosage can be
confirmed.
C) Explain to the client
that the dosage has been
changed.
D) Tell the client to take
the medication then
verify the dosage at the
next healthcare team
meeting.
The charge nurse is B) Viral meningitis whose temperature change from
making assignments for 101 S to 102F.
one practical nurse and
three registered nurses
who are caring for
neurologically
compromised clients.
Which client with which
change in status is best
to assign to the PN?
A) Subdural hematoma
whose blood pressure
changed from 150/80 to
170/60.
B) Viral meningitis whose
temperature change from
101 S to 102F.
C) Diabetic keto acidosis
who is Glasgow coma
scale score changed
from 10 to 7.
D) Myxedema, whose
blood pressure change
from 80/50 to 70/40.
The nurse is caring for a A) Maintain strict intake and output.
client with pneumonia
who now develops initial
signs of septic shock and
multi organ failure. The
healthcare provider
prescribes a sepsis
protocol. Which
intervention is most
important for the nurse to
include in the plan of
care?
A) Maintain strict intake
and output.
B) Keep head of bed
raised 45°.
C) Excess warmth of
extremities.
D) Monitor blood
glucose level.
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