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Questions 176

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Extract:


Question 1 of 5

The nurse is caring for a hospitalized client. Which is the best example of narrative documentation to provide legal malpractice protection for the nurse after an adverse event?

Correct Answer: C

Rationale: Detailed, objective documentation (
C) with times, actions, and follow-up plans provides the best legal protection. Options A, B, and D include assumptions, vague details, or irrelevant information.

Question 2 of 5

Which interventions does the nurse perform to promote normal rest and sleep patterns for a critically ill client? Select all that apply.

Correct Answer: A, C, D

Rationale: Dimming lights (
A), opening blinds in the morning (
C), and scheduling activities during the day (
D) promote circadian rhythms and rest. Leaving the TV on (
B) may disrupt sleep, and turning off alarms (E) compromises safety.

Question 3 of 5

A client diagnosed with hypertension has been prescribed a clonidine patch. Which instructions should the nurse include to reinforce prior teaching? Select all that apply.

Correct Answer: A, B, D

Rationale: Applying to upper arm/chest (
A), folding patches (
B), and rotating sites (
D) ensure safe use. Removing for dizziness (
C) requires medical consultation, and shaving (E) can irritate skin.

Question 4 of 5

The nurse is making assignments for the day's care. Which assignment should not be given to the nursing assistant?

Correct Answer: B

Rationale: Administering an enema requires nursing judgment and is outside a nursing assistant's scope. Other tasks are appropriate for a nursing assistant.

Question 5 of 5

While planning care for a 2 year-old hospitalized child, which situation would the nurse expect to most likely affect the behavior?

Correct Answer: B

Rationale: Separation from parents. Separation anxiety is the greatest stress for a toddler during hospitalization.

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