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Soru

Zorluk: OrtaReduction of Risk Potential

A licensed practical nurse (LPN) is caring for an older adult client who is recovering from a major abdominal surgery. Which of the following actions by the nurse demonstrate an appropriate application of risk reduction principles? Select all that apply.

  1. Withholding a scheduled dose of furosemide and alerting the registered nurse about a serum potassium level of 2.8 mEq/L.Cevap
  2. Promptly notifying the registered nurse when the client's heart rate increases to 115 beats per minute and blood pressure drops to 90/58 mm Hg.Cevap
  3. Verifying the client's name and date of birth against the medical record prior to obtaining a blood specimen.Cevap
  4. D
    Waiting for the healthcare provider's morning rounds to report a hemoglobin level of 6.7 g/dL (67 g/L) because the client is resting quietly.
  5. E
    Attributing a new trend of slight tachycardia and borderline hypotension to the expected effects of prescribed oral analgesics without further escalation.
  6. F
    Identifying the client by stating their name aloud and waiting for a nod of agreement before initiating a sterile dressing change.

Cevap

The correct actions include withholding furosemide for a critically low potassium level, reporting subtle but concerning changes in vital signs, and verifying two client identifiers prior to drawing blood.
The correct actions demonstrate proactive risk reduction. Severe hypokalemia (2.8 mEq/L) requires holding potassium-wasting diuretics and notifying the RN to prevent arrhythmias. Tachycardia combined with hypotension is an early sign of shock that requires immediate escalation. Finally, using two distinct identifiers before any procedure is a fundamental safety standard that reduces the risk of errors.

Adım Adım Çözüm

1
Analyze each action to determine if it mitigates or increases the client's risk for postoperative complications.
Identify actions that promote safety and rapid intervention.
Reduction of risk potential requires the nurse to anticipate complications and act proactively.
2
Evaluate the laboratory values and vital signs presented in the options.
Recognize that a potassium of 2.8 mEq/L and hemoglobin of 6.7 g/dL are critical. Note that a rising heart rate with dropping blood pressure indicates potential shock.
Accurate interpretation of clinical data is necessary to determine when to escalate care.
3
Select the options that reflect safe, evidence-based nursing practice.
The correct choices involve escalating critical labs and vital signs, and performing proper client identification.
These actions directly align with the LPN's role in reducing risk potential.

Anahtar Kavram

Reduction of Risk Potential through vital sign monitoring, critical lab escalation, and proper client identification.
Tahmini Süre:1m 30s
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Konular

Reduction of Risk Potential

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