A nurse is caring for a client whose hand movement is limited. What action should the nurse take to assist the client with feeding?

Provide an adaptive feeding device for the client.

Place the client in a lateral position.

Arrange the food groups clockwise on the plate.

Initiate a liquid diet for the client.

Answer and Explanation

The Correct Answer is A

The correct answer is choice A: Provide an adaptive feeding device for the client.

Choice A rationale: Providing an adaptive feeding device, such as a built-up utensil or a swivel spoon, can help clients with limited hand movement feed themselves independently. These devices are designed to make grasping and manipulating utensils easier, promoting independence and self-care.

Choice B rationale: Placing the client in a lateral position might not directly address the issue of limited hand movement, and it could even make feeding more challenging. This position is typically used for clients with swallowing difficulties or those at risk of aspiration.

Choice C rationale: Arranging food groups clockwise on the plate may help clients with visual impairments or cognitive issues, but it would not directly assist a client with limited hand movement during feeding.

Choice D rationale: Initiating a liquid diet for the client is not the most appropriate initial action to address limited hand movement. This might be considered as a last resort if the client is unable to feed themselves with any type of adaptive device or assistance. The priority should be promoting independence and providing appropriate tools to support self-feeding.

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Correct Answer is B

Explanation

Choice A rationale
While it’s true that a nasal cannula allows the patient to remove it for a while when it gets uncomfortable, this is not the primary reason for using a nasal cannula. The main purpose of a nasal cannula is to deliver oxygen.
Choice B rationale
A nasal cannula delivers the low concentration of oxygen that the patient needs. It is designed to provide a specific amount of oxygen, and the flow rate can be adjusted as needed.

Choice C rationale
While a nasal cannula does deliver a specific concentration of oxygen, it does not do so constantly. The amount of oxygen delivered can vary depending on the patient’s breathing rate and depth.
Choice D rationale
A nasal cannula does not deliver the highest concentration of oxygen possible. Other devices, such as non-rebreather masks, can deliver higher concentrations of oxygen.

A. Check that three fingers will fit beneath the restraints. B. Retie the restraint straps with a slipknot. C. Retie the restraint straps to the side rails. D. Remove the padding under the wrist restraints.

Correct Answer is B

Explanation

Choice A rationale

While it is important to ensure that restraints are not too tight, the issue in this scenario is not related to the tightness of the restraints.
Choice B rationale
Restraints should be tied with a slipknot to allow for quick release if necessary. A double knot may be difficult to untie quickly in an emergency.
Choice C rationale
Restraint straps should not be tied to the side rails. If the side rails are lowered, the restraints could become too loose.
Choice D rationale
The padding under the wrist restraints should not be removed. The padding helps to prevent skin damage and increase the comfort of the patient.

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A nurse is caring for a client whose hand movement is limited. What action should the nurse take to assist the client with feeding?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

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Correct Answer is B

Explanation

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