A client is ambulating with a two wheeled walker by rolling the walker forward and then moving each foot forward. The nurse notes that the client's elbows are slightly flexed when grasping the hand bar. After the client returns to the chair, which action should the nurse implement?

Offer to adjust the height of the walker.

Explain the need to remove the wheels from the walker.

Demonstrate more coordinated movement of the legs and walker.

Encourage the client to continue using the walker as observed.

Answer and Explanation

The Correct Answer is A

A.   The walker should be adjusted to the client's height so that their elbows are slightly flexed when grasping the hand bars. This allows for proper weight-bearing and reduces strain on the shoulders and arms. Using a walker that is the correct height can help to prevent falls by providing better stability and support.
B.   Removing the wheels from the walker would make it difficult for the client to use. The wheels are an important feature of a walker, as they allow the client to move more easily.
C.   While demonstrating more coordinated movement may be helpful, it's not the most immediate action needed. Adjusting the height of the walker is a more important step to ensure the client's safety and comfort.
D.   Encouraging the client to continue using the walker as observed may not be appropriate if the walker is not adjusted to the correct height. A properly adjusted walker is essential for safe and effective mobility.

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Correct Answer is B

Explanation

A. While it is true that using proper techniques can reduce the risk of back injuries for healthcare providers, this is not the primary purpose of the log rolling technique. The main goal of log rolling is to protect the client’s spinal alignment rather than focusing on the safety of the staff.
B. This is the best explanation for the purpose of using the log rolling technique. Log rolling is designed to keep the client’s spine in a straight, aligned position while turning. This technique is particularly important for clients with spinal injuries or conditions where maintaining spinal alignment is crucial to prevent further injury or complications.
C. While it is true that turning a client is generally better for skin integrity than pulling, this explanation does not specifically address the purpose of log rolling. Log rolling is more focused on maintaining spinal alignment rather than solely on reducing skin damage.
D. Using two or three people can indeed increase safety during the turning process and help in managing the client more effectively, but this explanation does not capture the primary purpose of the log rolling technique itself.

A. Ask the client to describe the pain experienced. B. Provide the client with a visual analog scale. C. Instruct the client in use of a numeric pain scale. D. Gently palpate the area and observe the response.

Correct Answer is A

Explanation

A. Asking the client to describe the pain is the most direct way to gather information about the quality of the pain. This approach allows the client to express characteristics such as whether the pain is sharp, dull, burning, aching, throbbing, or stabbing.
B. A visual analog scale (VAS) is useful for assessing the intensity of pain, not the quality. The VAS typically involves a line with endpoints representing no pain and worst possible pain, where the client marks their pain level.
C. The numeric pain scale is designed to measure the intensity of pain on a scale from 0 to 10, where 0 indicates no pain and 10 represents the worst pain imaginable. Like the VAS, this scale assesses pain intensity rather than quality.
D. Palpation and observing the client's response can help assess the location and intensity of pain, particularly if there are physical findings associated with the pain. However, this method does not provide information about the pain’s quality, such as its character or nature.

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A client is ambulating with a two wheeled walker by rolling the walker forward and then moving each foot forward. The nurse notes that the client's elbows are slightly flexed when grasping the hand bar. After the client returns to the chair, which action should the nurse implement?

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Naxlex Comprehensive Predictor Exams

Which explanation is best for the nurse to provide a client who asks the purpose of using the log rolling technique for turning?

Correct Answer is B

Explanation

When assessing a client's pain, the nurse determines the location and intensity of the pain. To gather data about the quality of the pain, which action should the nurse take?

Correct Answer is A

Explanation

The nurse assesses an older adult client's ability to perform activities of daily living (ADLs). When observing the client ambulate, the nurse notes that the client's posture is upright, and the gait is smooth and steady. Which action should the nurse take next?

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