A client begins to fall while the nurse is assisting with ambulation. What is the priority nursing intervention?
Initiate a code.
Call the charge nurse.
Guide the client safely to the floor.
Call the client's doctor.
The Correct Answer is C
The priority nursing intervention when a client begins to fall while ambulating is to guide the client safely to the floor.
This can help prevent injury and ensure the safety of the client.
CHOICE A. Initiating a code is not necessary for this situation as it is not a medical emergency.
CHOICE B AND D : Calling the charge nurse or the client’s doctor may be appropriate after the client has been safely guided to the floor and their condition has been assessed
[B] [D].
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Pressure injuries may be a result of decreased mobility.
When a person has decreased mobility, they may spend extended periods of time in one position, which can put pressure on certain areas of the body and lead to the development of pressure injuries.
Choice B is not an answer because diarrhea is not typically a result of decreased mobility.
Choice C is not an answer because euphoria is not typically a result of decreased mobility.
Choice D is not an answer because increased energy is not typically a result of decreased mobility.
Correct Answer is C
Explanation
This is an example of restating.
Restating is a therapeutic communication technique where the nurse repeats what the client has said in their own words to show that they are listening and to clarify the client’s message.
Choice A is incorrect because establishing trust involves building a relationship with the client and is not demonstrated in this example.
Choice B is incorrect because using silence involves allowing for pauses in the conversation to give the client time to think and reflect, which is not demonstrated in this example.
Choice D is incorrect because reassuring involves providing comfort and support to the client, which is not demonstrated in this example.
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