A nurse is assessing a client's ability to ambulate with crutches using a three-point gait. Which of the following actions should the nurse identify as a risk to the client's safety?

The client stands in a tripod position prior to walking.

The client keeps the elbows in a flexed position.

The client pushes downward on the handgrips.

The client places partial weight on the affected leg.

Answer and Explanation

The Correct Answer is D

A. Standing in a tripod position prior to walking with crutches is a correct stance to maintain balance and stability.
B. Keeping the elbows flexed helps absorb shock during ambulation and is appropriate when using crutches.
C. Pushing downward on the handgrips is necessary to generate upward force and support while using crutches.
D. Placing partial weight on the affected leg while ambulating with crutches using a three-point gait is incorrect and can jeopardize safety by potentially causing injury or instability.

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Correct Answer is B

Explanation

A. Positioning the wrapped package with the outer flap away helps maintain sterility when opening.
B. Holding gauze packages 15 cm (6 in) above the sterile field is incorrect; sterile items should be held at least 15 cm (6 in) above the sterile field to maintain sterility.
C. Holding a bottle of solution with the label away from the palm helps prevent contamination.
D. Wearing sterile gloves when handling sterile items on the sterile field helps maintain sterility.

A. Measure abdominal girth twice weekly. B. Monitor for the presence of WBCs in the urine. C. Apply pressure to needlestick sites for 10 min. D. Assess core temperatures using a rectal thermometer.

Correct Answer is C

Explanation

Rationale:
A. Measuring abdominal girth is not directly related to thrombocytopenia management.
B. Monitoring for WBCs in the urine is not related to thrombocytopenia.
C. Applying pressure to needlestick sites for 10 minutes helps prevent bleeding, which is crucial for clients with thrombocytopenia.
D. Using a rectal thermometer can increase the risk of bleeding and should be avoided in clients with thrombocytopenia.

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A nurse is assessing a client's ability to ambulate with crutches using a three-point gait. Which of the following actions should the nurse identify as a risk to the client's safety?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is observing a newly licensed nurse prepare a sterile field. For which of the following actions should the nurse intervene?

Correct Answer is B

Explanation

A nurse is planning care for a client who has thrombocytopenia. Which of the following interventions should the nurse include in the plan?

Correct Answer is C

Explanation

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