When assessing a patient's neurological status, which of the following is the most critical action by the nurse?

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Question 1 of 5

When assessing a patient's neurological status, which of the following is the most critical action by the nurse?

Correct Answer: C

Rationale: The Glasgow Coma Scale provides a systematic assessment of a patient's level of consciousness, which is crucial in determining neurological function.

Question 2 of 5

When caring for a client with a feeding tube, which intervention is most important to prevent complications?

Correct Answer: A

Rationale: Checking residuals ensures the feeding is tolerated and prevents complications such as aspiration.

Question 3 of 5

When teaching a client about the prevention of falls, which point is most important for the nurse to emphasize?

Correct Answer: A

Rationale: Removing throw rugs eliminates tripping hazards, reducing the risk of falls in the home environment.

Question 4 of 5

Which statement below is INCORRECT about the yellow triage tag color in regards to a disaster situation?

Correct Answer: A

Rationale: This statement is INCORRECT. It should say: A survivor with this tag color is seen after patients with the RED (not green) tag color.

Question 5 of 5

Which of the following nursing actions is most directly aimed at affording a client confidential treatment of his or her medical information while minimizing delay in accessing needed medical and nursing care?

Correct Answer: A

Rationale: Under new regulations, Health Insurance Portability and Accountability Act(HIPAA), in order to eliminate barriers that could delay access to care, required only that health care providers notify clients of their privacy policy and make a reasonable effort to get written acknowledgment of this notification.

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