A nurse is assessing a client whose therapy has included bed rest for several weeks.
Which of the following findings should the nurse identify as the priority?

Loss of appetite

Left lower extremity tenderness

Increased heart rate during physical activity

Musculoskeletal weakness

Answer and Explanation

The Correct Answer is B

A.   While decreased appetite may be concerning, it is not typically considered a priority over potential complications related to immobility.
B.   Left lower extremity tenderness could indicate deep vein thrombosis (DVT), a serious complication of prolonged bed rest that requires immediate attention to prevent pulmonary embolism.
C.   Increased heart rate during physical activity may be expected after a period of bed rest and can be addressed with gradual reconditioning.

D.   Musculoskeletal weakness is a common consequence of immobility and would be addressed as part of the client's rehabilitation but is not an immediate priority compared to potential complications like DVT.

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Correct Answer is ["A","C","D"]

Explanation

A. This abbreviation can be misinterpreted as "units," "cc," or "you." It is recommended to avoid its use to prevent misinterpretation.
B. This abbreviation stands for intake and output, which is commonly used in healthcare documentation and is not on The Joint Commission's Do Not Use list.
C. IU can be mistaken for intravenous or international unit.

D. This abbreviation stands for once daily and is prone to misinterpretation, as it can be mistaken for qid (four times daily). It is recommended to avoid its use to prevent dosing errors.
E. This abbreviation stands for pro re nata, indicating "as needed" medication administration, and is not on The Joint Commission's Do Not Use list.

A. Place their arms around the client to prevent the fall. B. Remain upright as the client fails toward them. C. Move quickly to a position in front of the client. D. Allow the client to slide down their outstretched leg.

Correct Answer is D

Explanation

A. This action may increase the risk of injury to both the nurse and the client.

B. This action does not effectively prevent the fall or minimize injury.

C. Moving quickly to a position in front of the client can cause imbalance and increase the risk for falling.
D. Allowing the client to slide down their outstretched leg can help prevent injury to both the client and the nurse.

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A nurse is assessing a client whose therapy has included bed rest for several weeks. Which of the following findings should the nurse identify as the priority?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is preparing to document in the client's medical record. The nurse should identify that which of the following abbreviations are specified by The Joint Commission for placement on a facility's Do Not Use list? (Select all that apply.)

Correct Answer is ["A","C","D"]

Explanation

A nurse is ambulating a client who is unsteady. The client begins to fall. Which of the following actions should the nurse take?

Correct Answer is D

Explanation

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A nurse is assessing a client whose therapy has included bed rest for several weeks.
Which of the following findings should the nurse identify as the priority?