A nurse is caring for a client who has lung cancer and has a sealed radiation implant. Which of the following actions should the nurse take? (Select all that apply)
Instruct visitors who are pregnant to remain 3 feet from the client.
Wear a lead apron when providing care.
Place the client in a semi-private room.
Close the door to the client’s room.
Limit visitors to 30 minutes per day.
Correct Answer : B,D,E
Choice A reason: Instructing pregnant visitors to stay 3 feet away is insufficient, as radiation from a sealed implant requires greater distance (typically 6 feet) or complete avoidance. Pregnant individuals should not visit to minimize fetal exposure, making this precaution inadequate and incorrect for safety.
Choice B reason: Wearing a lead apron shields the nurse from radiation exposure during close contact with the sealed implant, adhering to ALARA (As Low As Reasonably Achievable) principles. This protects the nurse while providing care, making it a necessary and correct safety measure.
Choice C reason: Placing the client in a semi-private room is unsafe, as radiation from the implant could expose other patients. A private room is required to minimize radiation risk to others, making this action incorrect and against radiation safety protocols.
Choice D reason: Closing the client’s door reduces radiation exposure to others outside the room, as sealed implants emit continuous radiation. This containment measure, combined with signage, ensures safety for staff and visitors, making it a correct and essential action.
Choice E reason: Limiting visitors to 30 minutes per day minimizes cumulative radiation exposure, protecting visitors from the sealed implant’s emissions. Time restrictions are standard in radiation safety protocols, ensuring minimal risk while allowing controlled visits, making this a correct action.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Thinking about wanting the procedure shows indecision, not consent understanding. Informed consent requires comprehension of the procedure, risks, and benefits, ensuring voluntary agreement. Contemplation alone is incomplete, failing to confirm the client’s grasp of the consent form’s legal purpose.
Choice B reason: Stating that signing indicates permission reflects understanding of informed consent, which documents voluntary agreement after receiving procedure details, risks, and benefits. This aligns with ethical and legal standards, confirming the client’s comprehension of the consent form’s role in authorizing surgery.
Choice C reason: Asking about risks indicates engagement but not consent understanding. It suggests a need for more information, not confirmation of the form’s purpose. While important, it does not reflect comprehension of the consent process as clearly as acknowledging the act of signing.
Choice D reason: Wanting to discuss concerns with the doctor shows the client seeks clarification, not that they understand the consent form’s purpose. It indicates an ongoing process, not confirmation of the form’s role in granting permission, unlike acknowledging the signing’s significance.
Correct Answer is A
Explanation
Choice A reason: Using a mechanical lift for a 136 kg client unable to assist ensures safety for both client and nurse. Lifts prevent injury by supporting the client’s weight, reducing strain on staff. This adheres to safe patient handling guidelines, minimizing risks of falls or musculoskeletal injuries during transfer.
Choice B reason: Asking another nurse to assist is insufficient for a 136 kg client unable to help, as manual lifting risks injury to staff and client. Mechanical lifts are required for heavy or non-assistive clients to ensure safety, making this option inadequate and unsafe for the transfer scenario described.
Choice C reason: Positioning the client upright before transfer is impractical for a non-assistive client weighing 136 kg, as it requires significant manual effort and risks injury. Mechanical lifts are needed to safely move such clients, ensuring stability and preventing falls, making this action inappropriate for the transfer.
Choice D reason: A sliding board is unsuitable for a 136 kg client unable to assist, as it requires some patient cooperation and strength. It risks injury to staff and client due to the client’s weight and inability to participate. Mechanical lifts are the safer, recommended method for this transfer.
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