general fundamentals

A nurse is assigned to care for a close friend in the hospital setting. Which action should the nurse take first when given the assignment?

• Notify the friend that all medical information will be kept confidential.

• Explain the relationship to the charge nurse and ask for reassignment.

• Approach the client and ask if the assignment is uncomfortable.

• Accept the assignment but protect the client’s confidentiality.

For the client with a sodium level of 128 mEq/L, which meal selections should the nurse suggest to the client? (Select all that apply.)

• Bacon, egg, and cheese biscuit

• Chinese chicken and vegetables, with rice and soy sauce

• Strawberry, spinach salad with yogurt-based blue cheese dressing

• Chicken salad stuffed fresh tomato with a side of celery sticks

• Grilled hot dog on a bun with ketchup and mustard

In the middle of running a resuscitation for a cardiac arrest the LPN states to the nurse, “What can I do for your other patients?” The nurse says to the LPN, “Go ahead and start that blood on the client in 434B. It is primed and ready to go. You have seen me do it a million times. You can do it.” What is the LPN’s best response?

• “No way am I starting the blood on that client!”

• “I am going to tell the manager you asked me to start blood.”

• “Sure, no problem. I can do that. I have done it before.”

• “I can take over compressions so you can start the blood.”

The nurse is talking with the spouse of a client admitted to the long-term care center. The client has end-stage renal cancer and is admitted for palliative care while awaiting hospice placement. The client often moans and groans, but is otherwise non-communicative and somnolent. What will the nurse include in the spouse’s teaching regarding the care of the client? (Select all that apply.)

• Repositioning every 2 hours

• Round-the-clock pain medication administration

• Assessment for skin breakdown

• Back rubs three times a day

• Bathing twice a day

The nurse is preparing an older client for discharge. Which method is best for the nurse to use when evaluating the client’s ability to perform a dressing change at home?

• Determine how the client feels about changing the dressing.

• Ask the client to describe the procedure in writing.

• Seek a family member’s evaluation of the client’s ability to change the dressing.

• Observe the client change the dressing unassisted.