A client was involved in a multi-car collision six days ago.

Sustained a liver laceration, right rib fracture, and right femur fracture. The liver laceration was repaired.

An intramedullary rod was placed to repair the femur fracture. The client is progressing.

The nurse is implementing the plan of care to increase mobility.

Complete the diagram by dragging from the choices area to specify which type of exercises the client needs, two actions the nurse should take to facilitate the exercises, and two parameters the nurse should monitor to assess the client’s progress.

Answer and Explanation

The Correct Answer is []

The correct answer is: Type of Exercises: Isometric exercises Isotonic exercises Actions to Take: Support the extremity Encourage active range of motion exercises Parameters to Monitor: Pain level Range of motion Rationale:

Isometric exercises: These exercises involve contracting the muscle without moving the joint. They are beneficial for maintaining muscle strength and preventing muscle atrophy, especially when the client is unable to perform full range of motion exercises due to pain or limited mobility. Isotonic exercises: These exercises involve moving the joint through its full range of motion with muscle contraction. They help improve muscle strength, endurance, and joint mobility. Isotonic exercises are important for clients who are progressing in their recovery and are able to tolerate more movement. Support the extremity: Providing support to the extremity during exercises helps prevent injury and reduces pain. It also ensures that the client performs the exercises correctly and safely. Encourage active range of motion exercises: Active range of motion exercises involve the client moving their own joints through their full range of motion. These exercises help improve joint mobility, muscle strength, and overall function. Encouraging the client to perform these exercises promotes independence and active participation in their recovery. Pain level: Monitoring the client’s pain level is important to ensure that the exercises are not causing excessive discomfort or injury. Pain management is crucial for promoting compliance with the exercise regimen and facilitating recovery. Range of motion: Assessing the client’s range of motion helps determine the effectiveness of the exercises and the progress of the client’s recovery. It also helps identify any limitations or areas that need further attention

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Correct Answer is C

Explanation

Choice A rationale

Asking the client if they understand after each instruction may not be effective if the client is not comfortable expressing confusion or misunderstanding. It does not allow for direct observation of the client’s ability to perform the necessary tasks.

Choice B rationale

Having an interpreter repeat the wound care instructions may be helpful, but it still does not allow for direct observation of the client’s ability to perform the necessary tasks.

Choice C rationale

Having the client demonstrate prescribed wound care is the best way to evaluate the client’s understanding of self-care at home. This allows the nurse to directly observe the client’s ability to perform the necessary tasks and provide feedback and clarification as needed.

Choice D rationale

Providing written instructions in the client’s native language may be helpful, but it does not allow the nurse to directly evaluate the client’s understanding

A. Report the client’s status to the healthcare provider. B. Ask the UAP to complete postmortem care. C. Begin cardiopulmonary resuscitation (CPR) and call a code. D. Notify the family of the client’s death. E. Notify the family of the client’s death.

Correct Answer is A

Explanation

Choice A rationale

Reporting the client’s status to the healthcare provider is the appropriate action. The healthcare provider needs to be informed of the client’s death to provide further instructions and complete necessary documentation. This action ensures proper communication and adherence to protocols.

Choice B rationale

Asking the UAP to complete postmortem care is necessary, but it should be done after notifying the healthcare provider. The nurse must follow the proper sequence of actions to ensure all protocols are followed.

Choice C rationale

Beginning cardiopulmonary resuscitation (CPR) and calling a code is not appropriate because the client has a signed do not resuscitate (DNR) form. Performing CPR would go against the client’s wishes and legal documentation.

Choice D rationale
Notifying the family of the client’s death is important, but it should be done after reporting the client’s status to the healthcare provider. The healthcare provider may have specific instructions for communicating with the family and completing necessary documentation.

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Naxlex Comprehensive Predictor Exams

A client who had emergency gallbladder surgery yesterday is getting ready for discharge. The client speaks very little English. When teaching wound care, which method should the nurse use to evaluate the client’s understanding of self-care at home?

Correct Answer is C

Explanation

An older adult client with heart failure has a signed do not resuscitate (DNR) form in the medical record. The unlicensed assistive personnel (UAP) reports that the client is not breathing, and the nurse confirms the UAP’s findings. Which action should the nurse take next?

Correct Answer is A

Explanation

A healthcare organization requires nurses to chart by exception. Which assessment should the nurse document?

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