A nurse is assessing a client who is 1 day postoperative following a total knee arthroplasty. The client is scheduled for physical therapy in 45 min. Which of the following questions should the nurse ask first?
“Have you used an incentive spirometer today?"
"What is your current pain level on a scale of 0 to 10?"
"Have you informed your family of your physical therapy schedule?"
"Would you like to bathe before or after physical therapy?"
The Correct Answer is B
A. While the use of an incentive spirometer is crucial for preventing respiratory complications such as atelectasis, this question is less urgent in the context of preparing for physical therapy. The immediate priority should be to assess the client’s readiness for physical therapy, including their pain level and comfort, rather than focusing on the spirometer use.
B. Assessing the client's current pain level is crucial because pain management directly impacts the
client’s ability to participate in physical therapy effectively. Ensuring that the client’s pain is adequately controlled will help in achieving a more successful therapy session and in preventing discomfort or additional complications during the therapy.
C. While informing family members about the physical therapy schedule might be important for planning family support and involvement, it is not as urgent as ensuring the client is physically ready for the therapy session.
D. This question addresses personal preference regarding bathing but is not as critical as assessing the client’s pain level or immediate readiness for physical therapy. While personal hygiene is important, it should not take precedence over addressing pain management and ensuring the client is prepared for physical therapy.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Reorienting the client can be part of care for someone with Alzheimer's disease, but it is more about providing direct care rather than advocacy. Advocacy involves taking actions to ensure the client's rights and needs are addressed in a broader sense, including facilitating their access to appropriate resources and services.
B. While performing cognitive assessments is important for monitoring the client's condition and adjusting care plans, it is primarily a clinical task. Advocacy involves supporting the client's overall well- being and ensuring they receive appropriate care and services, rather than just performing assessments.
C. By requesting a referral for reminiscent therapy sessions, the nurse is actively seeking additional support and resources that can enhance the client's quality of life. Reminiscent therapy can help clients with Alzheimer's disease by engaging them in activities that trigger positive memories and improve their emotional well-being.
D. Providing assistance with ambulation is an essential aspect of daily care and safety but does not specifically reflect advocacy. Advocacy involves broader actions that address the client’s needs and rights in a more comprehensive way, including accessing specialized services and resources.
Correct Answer is B
Explanation
A. While serving on a quality improvement committee is beneficial for long-term strategies and systemic changes, it is not the immediate action needed to address the specific increase in medication errors. The committee may work on broader issues and improvements over time, but addressing the current problem starts with understanding its root causes.
B. Conducting a root cause analysis (RCA) should be the first action. RCA is a systematic process for identifying the underlying causes of problems or events. By conducting an RCA, the nurse manager can determine the specific factors contributing to the increase in medication errors, whether they are related to processes, training, equipment, or other issues.
C. Developing preventative measures is essential for reducing future medication errors, but it should follow the root cause analysis. Without a clear understanding of the underlying causes, any preventative measures may not address the real issues or may be misdirected.
D. Reviewing current evidence-based practices is important for ensuring that care protocols align with the latest standards and guidelines. However, this should come after identifying the specific problems causing the medication errors.
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