NRB 131 Week PREP U Chapter 13

A nurse technician is assigned to take clients' vital signs. When making rounds, the nurse notices that one client's vital signs are very different from what they were at the beginning of the shift. What is most appropriate for the nurse to do about these findings?

Assess the client's vital signs again. Assessment is the collection of data that enables the nurse to make judgments about the level of care the client needs. The nurse should document assessment findings accurately, completely, concisely, factually, and in a timely manner. To ensure accurate assessment and documentation, the nurse should validate questionable data, not simply document them. Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care - Page 319

The nurse is attentive and responsive to the health care needs of individual clients and ensures the continuity of care when leaving these clients. What interpersonal skill is the nurse displaying?

Developing accountability - hold themselves accountable for the human well-being of clients entrusted to their care. - Being accountable means being attentive - responsive to the health care needs of individual clients - being concerned for the client in all situations - ensuring that continuity of care is in place when leaving a client. Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care - Page 309-310

A nurse has developed a plan of care for an adult client. What nursing function is important when using nursing diagnoses to guide the care of this client?

Prioritize the nursing diagnoses. Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care - Page 323

The nurse administers pain medication to a postoperative client. Which nursing intervention will assist with the client's unrelieved pain?

Repositioning the client Repositioning the client is a nursing intervention; it is nonpharmacologic and does not require a prescription from the health care provider and can assist with pain relief. Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care - Page 315

A nurse identifies the following: "The client will report a pain rating of 4 or less within 30 to 45 minutes of receiving prescribed analgesic." The nurse has identified:

outcome. (SMART goal) focuses on the client, is realistic, and is measurable. ---> planning Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care - Page 323