During Change-Of-Shift Report, the Nurse Learns About the Following Four

question 34

Multiple Choice

During change-of-shift report, the nurse learns about the following four clients. Which client requires the most rapid assessment?

• A)50-year-old with chronic pancreatitis who has gnawing abdominal pain
• B)48-year-old who has compensated cirrhosis and is complaining of anorexia
• C)45-year-old with cirrhosis and severe ascites who has an oral temperature of 38.8°C (101.8°F)
• D)56-year-old who is recovering from a laparoscopic cholecystectomy and has severe shoulder pain

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Definitions:

Unintentional Action

An act performed without conscious thought or intention.

Due to Exhaustion

A state or condition caused by severe physical or mental fatigue, often resulting from extreme effort or stress.

Availability Heuristic

The tendency to judge the frequency or likelihood of an event by the ease with which relevant instances come to mind

Correspondence Bias

The tendency to attribute a person's behavior to their disposition or personality while underestimating situational influences.