A nurse is assisting in the care of a client who has quadriplegia. Which of the following actions should the nurse take?
Place the client’s glasses on the bedside table.
Place the call light within the client’s reach.
Check on the client every 4 hr.
Place the client in a room near the nurses’ station.
The Correct Answer is B
Choice A reason: Glasses on the bedside table may be inaccessible for a quadriplegic client lacking arm movement. This doesn’t ensure immediate utility or safety. Scientifically, quadriplegia limits motor function, requiring adaptive aids within reach, making this less practical than direct assistance options.
Choice B reason: Placing the call light within reach empowers the quadriplegic client to summon help, addressing their limited mobility. This aligns with scientific rehabilitation principles, enhancing independence and safety by ensuring communication access, critical for managing needs in paralysis effectively.
Choice C reason: Checking every 4 hours is insufficient for quadriplegia, where urgent needs (e.g., pressure sores) arise faster. Scientifically, frequent monitoring is standard, and this gap risks neglect, making it less proactive than enabling client-initiated contact for timely care and intervention.
Choice D reason: A room near the station aids staff response but doesn’t guarantee immediate help without client input. Scientifically, proximity alone doesn’t address quadriplegia’s dependency needs as directly as a call light, which ensures the client can signal distress promptly.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Tetracycline allergy doesn’t cross-react with azithromycin, a macrolide. They’re distinct classes, so this isn’t a concern for chlamydia treatment safety.
Choice B reason: Sulfonamide allergy is unrelated to azithromycin’s macrolide structure. No cross-sensitivity exists, making this irrelevant for reporting in this case.
Choice C reason: Azithromycin is a macrolide; allergy to this class risks anaphylaxis. Reporting ensures safe alternative prescribing for chlamydia, a critical safety step.
Choice D reason: Penicillin allergy doesn’t affect azithromycin use; they’re unrelated structurally. This doesn’t require reporting, as no cross-reaction occurs here.
Correct Answer is D
Explanation
Choice A reason: Swallowing isn’t an option for chewable isosorbide; it’s designed for sublingual absorption. This advice is incorrect and won’t address vasodilatory headache effects.
Choice B reason: Discontinuing isosorbide risks angina exacerbation in cardiac patients. Headaches are tolerable side effects, so stopping isn’t advised without provider input.
Choice C reason: Empty stomach intake doesn’t reduce isosorbide’s vasodilatory headaches. Timing doesn’t alter its nitrate-induced vessel dilation, making this ineffective advice.
Choice D reason: Headaches from isosorbide’s vasodilation typically subside with tolerance over time. This reassures the client, aligning with expected nitrate therapy adaptation.
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