A nurse is planning to transfer a client who weighs 136 kg (300 lb) from a bed to a chair. The client is unable to assist in the transfer. Which of the following actions should the nurse plan to take?

Use a mechanical lift to transfer the client.

Ask another nurse to assist with the transfer.

Position the client upright before transferring.

Use a sliding board to transfer the client.

Answer and Explanation

The Correct Answer is A

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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Correct Answer is C

Explanation

Choice A reason: Starting work in a parking garage while on warfarin does not inherently indicate a need for referral unless specific risks (e.g., injury prone to bleeding) are present. Without additional concerns, this situation is routine, making it incorrect for requiring further care.
Choice B reason: Increased urinary frequency with bumetanide, a diuretic, is an expected side effect, not requiring referral unless severe or accompanied by electrolyte imbalances. This is a normal response, so it does not warrant further care, making it incorrect.
Choice C reason: An induration 48 hours after a Mantoux test suggests a positive tuberculosis result, requiring referral for chest X-ray and further evaluation. This finding indicates potential latent or active TB, a significant health concern, making it the correct choice for referral.
Choice D reason: Being 1 day postoperative after knee replacement is expected, with routine monitoring for complications like infection or thrombosis. Without specific issues, this does not require referral beyond standard postoperative care, making it incorrect.

A. Limit your child's potassium intake while she is taking this medication. B. Repeat the dose if your child vomits within 1 hour after taking the medication. C. You can add the medication to a half-cup of your child's favorite juice. D. Have your child drink a small glass of water after swallowing the medication.

Correct Answer is D

Explanation

Choice A reason: Limiting potassium intake is dangerous with digoxin, as low potassium (hypokalemia) increases the risk of digoxin toxicity by enhancing drug binding to cardiac cells. Adequate potassium levels are critical for safe use, as digoxin affects cardiac contractility, making this instruction incorrect and potentially harmful.
Choice B reason: Repeating a digoxin dose if the child vomits within 1 hour is unsafe without medical consultation, as it risks overdose. Digoxin has a narrow therapeutic index, and toxicity can cause arrhythmias. Parents should contact the provider for guidance, making this instruction incorrect and dangerous.
Choice C reason: Adding digoxin to juice risks inaccurate dosing, as the child may not consume the full amount, leading to underdosing or toxicity if additional doses are given. Precise administration (e.g., via syringe) ensures correct dosing, critical for digoxin’s narrow therapeutic range, making this instruction inappropriate.
Choice D reason: Having the child drink water after digoxin ensures the dose is fully swallowed, preventing loss from spitting or incomplete ingestion. This supports accurate dosing, essential for digoxin’s safe use in heart failure, where it enhances cardiac output. This instruction is safe and effective, making it correct.

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A nurse is planning to transfer a client who weighs 136 kg (300 lb) from a bed to a chair. The client is unable to assist in the transfer. Which of the following actions should the nurse plan to take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is providing teaching to a client who has a new prescription for warfarin. Which of the following findings requires a referral for further care?

Correct Answer is C

Explanation

A nurse is providing teaching about digoxin administration to the parents of a toddler who has heart failure. Which of the following statements should the nurse include in the teaching?

Correct Answer is D

Explanation

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