Performance by Client Needs

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A nurse is caring for a client following a tonsillectomy and fails to routinely assess the back of the client's throat for signs of bleeding. The nurse manager reviews the client's chart and notices the omission of the assessments. Which is the best response to the nurse regarding the missing assessments?

"Failure to complete these assessments constitutes negligent behavior."

A client diagnosed with schizophrenia for the last 2 years tells the nurse who has brought the morning medications, "That's not my pill! My pill is blue, not green." What should the nurse tell the client?

"I'll go back and check the drawer as well as telephone the pharmacy to check about any possible changes in the medication color."

The nurse is precepting a graduate nurse and preparing to give infant immunizations. The preceptor asks the graduate, "Infant injections should only be given in which muscle?" What is the best response by the graduate nurse?

"vastus lateralis"

When discharging a 5-month-old infant from the hospital, the nurse checks to see whether the parent's car restraint system for the infant is appropriate. Which restraint system would be safest?

A rear-facing infant safety seat in the middle of the back seat

Which topic would be most important to include when teaching the parents how to promote overall toddler development?

Safety is a priority concern for this age group.


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