A nurse is assisting a client who requests to take a tub bath. Which of the following actions should the nurse take?
Check on the client every 10 min during the bath.
Add bath oil to the water after the client gets into the tub.
Drain the tub water before the client gets out.
Allow the client to remain in the bath for 30 min.
The Correct Answer is C
Answer is: Drain the tub water before the client gets out.
Explanation: This is the correct answer because it reduces the risk of slipping and falling for the client, especially if they have limited mobility or balance problems. The other options are incorrect because:
- Checking on the client every 10 min during the bath is not enough to ensure their safety and comfort. The nurse should check on them more frequently, such as every 5 to 10 minutes, depending on their needs and preferences.
- Adding bath oil to the water after the client gets into the tub is not a good idea because it can make the water slippery and increase the risk of falling. The nurse should add bath oil to the water before the client gets into the tub, or use a non-slip mat or shower chair.
- Allowing the client to remain in the bath for 30 min is too long and can cause dehydration, hypothermia, or skin irritation. The nurse should instruct the client to remain in the tub for no longer than 20 min, unless otherwise ordered by a physician.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Incorrect. No sounds heard after listening for 3 to 5 minutes would be considered absent bowel sounds.
B. Correct. Hyperactive bowel sounds are louder and more frequent than normal and can indicate increased bowel motility. They can also be present in early bowel obstructions due to increased peristalsis.
C. Incorrect. Soft sounds at a rate of 1/min are within the range of normal bowel sounds.
D. Incorrect. Decreased motility would result in hypoactive bowel sounds, not hyperactive.
Correct Answer is B
Explanation
A. Meningococcal immunization typically includes different schedules and doses; stating three doses before kindergarten is not accurate.
B. Correct. The rotavirus vaccine is administered orally to infants.
C. Feeding restrictions before immunizations are not routinely required for infants.
D. While some mild fever after immunizations is possible, the statement suggests an expectation of a high fever for 24 hours, which is not accurate.
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