A nurse is providing teaching to a client about reducing the adverse effects of immobility.
Which of the following statements by the client indicates an understanding of the teaching?
"I will perform ankle and knee exercises every hour."
"I will have my partner help me change positions every 4 hours."
"I will remove my antiembolic stockings while I am in bed."
"I will hold my breath when rising from a sitting position."
The Correct Answer is A
A. Regular ankle and knee exercises help prevent muscle atrophy due to immobility.
B. Changing positions every 4 hours is helpful, but more frequent movement is recommended.
C. Antiembolic stockings should be worn when immobile to prevent blood clots.
D. Holding breath during movement doesn't contribute to reducing adverse effects of immobility.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. In emergency situations where the client is unconscious and requires immediate life-saving surgery, implied consent is assumed. The nurse should prepare the client for surgery without waiting for family members or a formal consent process. Delaying treatment could jeopardize the client's life.
B. Contacting the ethics committee could delay the urgent care needed in an emergency situation. Immediate action should be taken in the best interest of the client.
C. Waiting for a family member to arrive could delay critical care, which may lead to worsening of the client's condition or even death.
D. The surgeon does not need to provide consent. It is the healthcare team's responsibility to act in the client's best interest when the client is unable to provide consent in an emergency.
Correct Answer is A
Explanation
A. Eyelashes that curl slightly outward is a normal finding.
B. An involuntary blink rate of 30 to 35 times per minute might be within the normal range but is not typically assessed during a routine eye examination.
C. Pupils of 8 to 9 mm in diameter might indicate dilation, which is not a normal finding during a regular eye assessment.
D. Corneas with an opaque appearance could indicate issues such as corneal edema or opacity, which are abnormal findings.
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