A nurse is caring for a client who is postoperative and is preparing to walk for the first time in several days.
Which of the following instructions should the nurse give the client to prevent orthostatic hypotension?

“Perform regular isometric exercises.”.

“Increase your intake of protein.”.

“Dangle your legs over the side of the bed.”.

“Use your incentive spirometer.”.

Answer and Explanation

The Correct Answer is C

The correct answer is choice C. “Dangle your legs over the side of the bed.” This helps prevent orthostatic hypotension, which is a form of low blood pressure that happens when standing after sitting or lying down.

Dangling the legs over the side of the bed allows blood to flow back to the heart and increases blood pressure before standing up.

Choice A is wrong because “Perform regular isometric exercises.” Isometric exercises are muscle contractions without movement, such as squeezing a ball or clenching a fist.

These exercises do not help with orthostatic hypotension because they do not improve blood circulation or blood pressure.

Choice B is wrong because “Increase your intake of protein.” Protein intake does not affect orthostatic hypotension directly.

However, staying hydrated by drinking plenty of fluids can help prevent or manage the condition by maintaining blood volume and blood pressure.

Choice D is wrong because “Use your incentive spirometer.” An incentive spirometer is a device that helps improve lung function after surgery by encouraging deep breathing.

It does not prevent orthostatic hypotension because it does not affect blood pressure or blood flow.

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Correct Answer is D

Explanation

The correct answer is choice D. Flex hips and knees when assisting the client to a standing position.

Choice A rationale:

Raising the bed to waist level before moving the client is not recommended because it can increase the risk of falls and injuries. The bed should be at a height that allows the nurse to maintain proper body mechanics and ensure the client’s safety during the transfer.

Choice B rationale:

Pivoting on the foot farthest from the bed when assisting the client into the chair is incorrect. The nurse should pivot on the foot closest to the bed to maintain stability and control during the transfer.

Choice C rationale:

Standing on the client’s stronger side when moving the client into the chair is not the best practice. The nurse should stand on the client’s weaker side to provide support and prevent the client from falling towards their weaker side.

Choice D rationale:

Flexing hips and knees when assisting the client to a standing position is correct. This technique helps the nurse maintain proper body mechanics, reduces the risk of injury, and provides better support to the client during the transfer.

A. Chlorhexidine. B. Isopropyl alcohol. C. Chlorine bleach. D. Triclosan.

Correct Answer is C

Explanation

According to the CDC1, chlorine bleach is an effective disinfectant for killing C. difficile spores on environmental surfaces.

It should be used in a 1:10 dilution of household bleach and water, freshly mixed daily.

Chlorine bleach can also kill other pathogens that may be present in the room of a client with C. difficile infection.

Choice A is wrong because chlorhexidine is not effective against C. difficile spores.

Chlorhexidine is an antiseptic that can be used for hand hygiene and surgical asepsis, but it does not kill spores.

Choice B is wrong because isopropyl alcohol is also not effective against C. difficile spores.

Alcohol-based hand sanitizers are not sufficient for preventing the spread of C. difficile, and soap and water should be used instead.

Choice D is wrong because triclosan is a type of antibacterial agent that is commonly found in some consumer products, such as soap and toothpaste. However, triclosan has no activity against C. difficile spores.

Triclosan may also contribute to antibiotic resistance and has potential adverse effects on human health and the environment.

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A nurse is caring for a client who is postoperative and is preparing to walk for the first time in several days. Which of the following instructions should the nurse give the client to prevent orthostatic hypotension?

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A nurse is caring for a client who is postoperative and is preparing to walk for the first time in several days.
Which of the following instructions should the nurse give the client to prevent orthostatic hypotension?