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A nurse is preparing to place a belt restraint on a client. In what order should the nurse take the following actions? (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)

Place the client in a lying position.

Thread the ties through the belt.

Apply the belt at the client's waist over his clothing.

Assist the client to a sitting position.

Attach restraint straps to the bedframe.

Answer and Explanation

The Correct Answer is A,D,C,B,E

Place the client in a lying position. This step ensures that the client is in a stable and safe position before applying the restraint.
Assist the client to a sitting position. Once the client is stable, assisting them to a sitting position ensures that they are comfortably positioned for restraint application.
Apply the belt at the client's waist over his clothing. Applying the belt over the clothing at the waist secures the client and prevents movement.
Thread the ties through the belt. Threading the ties through the belt ensures that the restraint is properly secured.
Attach restraint straps to the bedframe. Finally, attaching the restraint straps to the bedframe ensures that the restraint is firmly secured and the client cannot easily remove it.

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Correct Answer is B

Explanation

A. "Perform vigorous intensity aerobic exercise for 50 minutes per week." The TLC diet recommends moderate-intensity physical activity for at least 30 minutes most days of the week, totaling about 150 minutes per week. Vigorous exercise is beneficial but is not the primary focus of the TLC guidelines.
B. "Increase your intake of total fiber to 30 grams each day." This is correct. Increasing fiber intake to 20-30 grams per day is a key component of the TLC diet, as it helps to lower LDL cholesterol and improve overall heart health.
C. "You will have your LDL measured every 6 months." While regular monitoring of LDL levels is important, the TLC guidelines do not specify that LDL should be measured every 6 months. Frequency of monitoring should be individualized based on the client's health status and risk factors.
D. "You should have a weight loss goal of 3 pounds per week." A weight loss goal of 1-2 pounds per week is recommended as safe and sustainable. Aiming for 3 pounds per week may be too aggressive and difficult to maintain.

A. Ask the client to tilt her head back when swallowing. B. Offer the client larger portions of food during the meal. C. Use spoons, instead of cups, when serving liquids to the client. D. Encourage the client to complete the meal within 15 min.

Correct Answer is C

Explanation

A. Ask the client to tilt her head back when swallowing. Tilting the head back can increase the risk of aspiration. Clients with dysphagia should be instructed to tuck their chin to their chest when swallowing.
B. Offer the client larger portions of food during the meal. Smaller portions are safer for clients with dysphagia to reduce the risk of choking and aspiration.
C. Use spoons, instead of cups, when serving liquids to the client. This is correct. Using spoons can help control the amount of liquid the client receives, reducing the risk of aspiration.
D. Encourage the client to complete the meal within 15 min. Rushing a meal increases the risk of choking and aspiration. Clients with dysphagia should eat slowly and take small bites.

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A nurse is preparing to place a belt restraint on a client. In what order should the nurse take the following actions? (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is B

Explanation

A nurse is assisting a client who has dysphagia at meal time. Which of the following actions should the nurse take?

Correct Answer is C

Explanation

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