A nurse is teaching a client who has a spinal cord injury and is currently wearing a halo fixation device. Which of the following statements should the nurse include in the teaching?
"You can loosen the pins on the device for comfort."
"You should wrap the pins with cloth in cold weather."
"You can remove the device at night for sleep."
"You should only drive during daylight hours."
The Correct Answer is B
Rationale:
A. "You can loosen the pins on the device for comfort." The pins of a halo fixation device must remain firmly secured at all times. Loosening them can destabilize cervical alignment and significantly increase the risk of spinal injury or complications.
B. "You should wrap the pins with cloth in cold weather." The metal components of the halo device can become very cold and cause skin injury or discomfort. Wrapping the pins with cloth provides insulation and protects the skin from cold-related damage.
C. "You can remove the device at night for sleep." The halo device must be worn continuously, including during sleep, to maintain cervical immobilization. Removing it compromises spinal stability and can result in serious harm.
D. "You should only drive during daylight hours." Clients with a halo device are generally advised not to drive at all due to restricted head movement and limited field of vision, regardless of the time of day.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Rationale:
A. Communicate information about the new policy to nursing staff: This occurs after the policy is developed and approved. It is important for implementation but is not the first step in policy development.
B. Create options for implementing the new policy: This step follows initial research and policy design. It cannot be done until there is a clear understanding of requirements and goals.
C. Research the requirements of accrediting agencies that are related to the new policy: This is the first step to ensure the policy aligns with regulatory standards and evidence-based practices. It provides a foundation for developing relevant and compliant guidelines.
D. Review feedback from nursing staff to determine the effectiveness of the new policy: This is part of the evaluation phase, which happens after the policy has been implemented and trialed.
Correct Answer is D
Explanation
Rationale:
A. "Ensure that she adheres to a low-protein diet." A high-protein meal may interfere with the absorption of levodopa, but a complete low-protein diet is not recommended. The timing of protein intake should be considered rather than restricting it entirely.
B. "Have her complete as many activities as possible by herself." While promoting independence is important, clients with Parkinson’s disease may require assistance, especially during "off" periods. Overemphasis on independence can increase the risk of injury and frustration.
C. "Give her the prescribed medications after meals." Levodopa should usually be taken on an empty stomach or away from high-protein meals to enhance absorption. Taking it after meals can reduce effectiveness unless GI upset occurs.
D. "Schedule physical therapy sessions for her early in the morning." Parkinson’s symptoms often worsen as the day progresses. Morning sessions, when medication is most effective, can optimize motor performance and reduce fatigue during therapy.
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