A client is recovering from an endoscopy and the nurse notes the client is drooling and coughing. What should the nurse assess first?

Correct Answer: A

Rationale: Post-endoscopy, drooling and coughing suggest impaired swallowing, so the nurse assesses the gag reflex first over oximetry, pupils, or lungs. Sedation can blunt this reflex, risking aspiration gag absence signals danger, needing airway protection before oxygen or neurological checks. Leadership prioritizes airway safety; imagine a client choking on saliva testing gag (e.g., with a tongue depressor) guides suction or positioning, preventing pneumonia. This focus ensures rapid, life-saving decisions, aligning with nursing's vigilance in post-procedure care, where seconds count.

Correct Answer: A

Rationale: Post-endoscopy, drooling and coughing suggest impaired swallowing, so the nurse assesses the gag reflex first over oximetry, pupils, or lungs. Sedation can blunt this reflex, risking aspiration gag absence signals danger, needing airway protection before oxygen or neurological checks. Leadership prioritizes airway safety; imagine a client choking on saliva testing gag (e.g., with a tongue depressor) guides suction or positioning, preventing pneumonia. This focus ensures rapid, life-saving decisions, aligning with nursing's vigilance in post-procedure care, where seconds count.

Correct Answer: B

Rationale: I' acts, me' is observed , not A, C, D. Nurse leaders like self-reflection use this, contrasting with confusion. In healthcare, it clarifies identity, aligning leadership with self-awareness.

Correct Answer: B

Rationale: Insisting on removing mandatory overtime and penalties reflects patient safety concerns fatigued nurses from excessive hours risk errors, compromising care quality. Studies link overtime to increased incidents, a pressing issue in high-stakes settings. Autonomy (decision-making freedom), accountability (duty fulfillment), and authority (power to act) matter, but safety drives this stance, as overwork directly threatens patients, aligning with nursing's core mission and your advocacy as a staff rep to protect both nurses and those they serve.

Correct Answer: A

Rationale: In suspected hypocalcemia, muscle cramps support it, not hyperreflexia, moist skin, or fast pulse (hypercalcemia signs). Low calcium causes tetany cramps signal need for replacement. Leadership notes this imagine twitching; it guides treatment, aligning with electrolyte care effectively. This reflects nursing's diagnostic precision.

Correct Answer: A

Rationale: Leadership fits role models, not non-communicative, frightening, or self-oriented. Nurse leaders like mentors exemplify this, contrasting with negatives. In healthcare, it's guidance, aligning leadership with example.

Correct Answer: A

Rationale: Digoxin, for heart failure or arrhythmias, slows heart rate, risking bradycardia if <60 bpm contraindicating administration. Checking the apical pulse before administration (1 minute, apex) ensures safety, holding the dose if below threshold (per order), a standard precaution to prevent toxicity. Giving with food isn't required absorption is consistent while blood pressure monitoring, though useful, isn't primary pulse rate is. IV push is rare digoxin is slow IV or oral. Pulse checking aligns with cardiac med protocols, safeguarding against adverse effects (e.g., heart block), reflecting the nurse's critical role in pre-administration assessment for a narrow-therapeutic drug.

Correct Answer: B

Rationale: Time management isn't a symptom, unlike headaches, fatigue, or GI issues. Nurse leaders like spotting burnout identify effects, contrasting with tools. In healthcare, recognizing distress aids intervention, aligning leadership with staff health awareness.

Correct Answer: A

Rationale: For valproic acid in seizures, monitor liver enzymes, not creatinine, glucose, or platelets. It risks hepatotoxicity ALT/AST rise flags damage. Others are secondary. Leadership watches this imagine jaundice; it ensures safety, aligning with seizure care effectively.