A nurse is using a bladder scanner to assess the bladder volume of a client with urinary frequency. In which position would the nurse place the client?
Sims’ position
Dorsal recumbent position
Supine position
High Fowler’s position
The Correct Answer is B
Choice A rationale:
Sims' position is a side-lying position with the lower leg flexed and the upper leg extended. It is not ideal for bladder scanning because it can compress the bladder and make it difficult to obtain an accurate reading.
Additionally, in Sims' position, the bladder may not be fully accessible to the scanner, as it may be partially obscured by the upper thigh.
Choice B rationale:
Dorsal recumbent position is the optimal position for bladder scanning. In this position, the client lies flat on their back with their knees bent and their feet flat on the bed. This position allows for:
Full exposure of the bladder, making it easily accessible to the scanner.
Relaxation of the abdominal muscles, which can help to ensure an accurate reading.
A comfortable position for the client, promoting cooperation and reducing the likelihood of movement that could interfere with the scan.
Choice C rationale:
Supine position is a similar position to dorsal recumbent, but with the legs fully extended. While it is possible to perform a bladder scan in this position, it is not as ideal as dorsal recumbent because:
The extended legs can place some tension on the abdominal muscles, potentially affecting bladder position and the scan's accuracy.
The client may find this position less comfortable, leading to restlessness and potential movement that could interfere with the scan.
Choice D rationale:
High Fowler's position is a semi-sitting position with the head of the bed elevated at a 45- to 60-degree angle. This position is not suitable for bladder scanning because:
Gravity can pull the bladder downwards, making it difficult to visualize and measure accurately.
It can be challenging to maintain proper positioning of the scanner on the abdomen in this position, potentially leading to inaccurate readings.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale:
It is inappropriate and dismissive to tell a client who has experienced a traumatic loss that they should be grateful to be alive. This statement invalidates the client's feelings of grief and loss, and it can hinder the coping process.
It is important for nurses to recognize that grief is a normal and healthy response to loss.
Telling a client to be grateful can imply that their feelings of grief are not valid or that they are not coping appropriately. This can lead to feelings of guilt, shame, and isolation, which can further complicate the grieving process.
Choice B rationale:
It is incorrect to label a client's grief as an abnormal or inappropriate response. Grief is a universal human experience, and there is no right or wrong way to grieve.
Each individual grieves in their own way and at their own pace.
Some people may express their grief openly, while others may grieve more privately.
It is important for nurses to respect the client's individual grieving process and to provide support without judgment. Choice C rationale:
It is important for nurses to recognize that grief is a normal and healthy response to loss.
It is a natural process that allows individuals to come to terms with their loss and to adjust to life without their loved one or without a part of their body.
Experiencing grief does not mean that there is something wrong with the client.
In fact, it is a sign that the client is beginning to process their loss.
Choice D rationale:
While tissue healing is important, it is not the only factor that will help the client to adapt to their loss. The client will also need to address the emotional and psychological aspects of their loss.
This may involve talking about their feelings, seeking support from others, and finding ways to cope with their grief.
Correct Answer is D
Explanation
Choice A rationale:
Secondary prevention focuses on early detection and treatment of diseases or conditions to prevent complications or progression. It does not involve education about health promotion activities like exercise.
Examples of secondary prevention include:
Screening for cancer (e.g., mammograms, colonoscopies)
Regular blood pressure checks
Immunizations
Taking medications to manage chronic conditions (e.g., diabetes, hypertension)
Choice B rationale:
Restorative care aims to restore function and quality of life after an illness or injury. It does not encompass health education strategies like the nurse's action in this scenario.
Examples of restorative care include:
Physical therapy
Occupational therapy
Speech therapy
Rehabilitation programs
Choice C rationale:
Tertiary prevention focuses on managing existing diseases or conditions to prevent further complications and improve quality of life. It's not applicable to this scenario as no disease or condition is being managed.
Examples of tertiary prevention include:
Cardiac rehabilitation after a heart attack
Diabetes management education
Pulmonary rehabilitation for chronic lung disease
Choice D rationale:
Primary prevention targets preventing diseases or conditions from occurring in the first place. It often involves education and lifestyle changes to promote health and wellness.
The nurse's action of educating adolescents about physical exercise aligns with primary prevention. Exercise has proven benefits in:
Reducing the risk of chronic diseases like obesity, heart disease, stroke, type 2 diabetes, and some types of cancer Improving mental health and well-being
Promoting bone and muscle health
Enhancing sleep quality
Reducing stress levels
Therefore, the nurse's activity of educating adolescents about exercise represents primary prevention.
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