A nurse is using Maslow's hierarchy to prioritize care for an anxious patient that is not eating and will not see family members. Which area should the nurse address first?

A) The client should first move the strong leg, then the weak one:
This instruction is not appropriate for cane use. When using a cane, the client should move the cane forward first, followed by the weak leg, and then the strong leg. This ensures proper support and balance while ambulating. Moving the strong leg first could cause instability and increase the risk of falls.

B) When the client moves, he should move the cane forward first:
This statement is partly correct, but it's only one part of the proper technique for cane use. The cane should be moved forward first, but then the weak leg should follow, and the strong leg should move last. This sequence helps the client maintain balance while using the cane.

C) The client should hold the cane on the weak side of his body:
This is the correct instruction. The cane should be held on the weak side (the side with the injury or decreased strength) to provide support and maintain balance while ambulating. Holding the cane on the weak side helps to transfer weight from the weak leg to the cane, improving stability and mobility.

D) The grip should be level with the client's wrist:
This statement is partially correct but lacks clarity. The cane's grip should be level with the client's wrist when standing upright, which ensures that the client can hold the cane with a slightly bent elbow, promoting better posture and more effective use of the device. However, it is essential to make sure the cane height is adjusted to the individual's specific needs, as the wrist level may not always be ideal for every client.

A) The nurse opens the top flap of a sterile tray toward the body when assisting the provider with a thoracentesis: This is incorrect technique. The sterile field should always be maintained, and when opening sterile trays, the nurse should open the flap away from the body to avoid contaminating the sterile field. Opening the flap toward the body increases the risk of contamination and compromises sterility, which is critical in maintaining aseptic technique during procedures.

B) The nurse uses clean gloves when discontinuing a client's intravenous infusion: Using clean gloves when discontinuing an intravenous infusion is appropriate. Clean gloves are sufficient for this non-sterile task, as the procedure does not involve direct contact with sterile body tissues or fluids. Sterile gloves are not necessary unless the task requires maintaining sterility, such as inserting a catheter.

C) The nurse uses the client's telephone number as one form of identification when administering medications to a client: This is a correct action, as the nurse is verifying the patient's identity before administering medication. It is important to use at least two identifiers (such as the patient's name and date of birth or medical record number) to ensure accurate identification, and the patient's telephone number can be an additional form of identification.

D) The nurse empties the client's drainable colostomy pouch when it is one third full: This is an appropriate action. The nurse should empty the colostomy pouch when it is one third to one half full to prevent leakage or discomfort. This action is part of proper colostomy care and helps maintain hygiene and comfort for the patient.