A nurse manager observes assistive personnel (AP) incorrectly transferring a client to the bedside commode. Which of the following actions should the nurse take first?
Help the AP assist the client with the transfer
Demonstrate the proper client transfer technique to the AP
Instruct the AP to request assistance when unsure about a task
Refer the AP to the facility procedure manual
The Correct Answer is A
A. Helping the assistive personnel immediately ensures the client’s safety, which is the nurse’s top priority. Incorrect transfer techniques can lead to falls or injury, so the nurse must intervene right away to prevent harm.
B. Demonstrating proper transfer technique is important for education, but it should occur after the immediate safety issue is resolved.
C. Instructing the AP to request assistance when unsure is appropriate teaching, but it does not address the immediate risk to the client during the transfer.
D. Referring the AP to the procedure manual is not a priority in an active situation where the client could be injured. Education and reference can occur later.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
a. Occupational therapy focuses on assisting individuals in performing activities of daily living and may not directly address wheelchair mobility needs.
b. Social services may provide assistance with community resources and support including sourcing for a wheelchair.
c. Home health services may provide skilled nursing care in the home but may not directly address wheelchair mobility needs.
d. Physical therapy specializes in mobility and rehabilitation but arent the best placed to provide the client with resources on access to a wheelchair.
Correct Answer is B
Explanation
a. Providing a rest period prior to meals may be appropriate for some clients, but it is not a standard technique for managing dysphagia during mealtime.
b. Elevating the head of the client’s bed to 30 degrees during mealtime helps prevent aspiration and facilitates swallowing in clients with dysphagia.
c. Instructing the client to place her chin toward her chest when swallowing is not recommended and may increase the risk of aspiration.
d. Withholding fluids until the end of the meal is not recommended for clients with dysphagia, as they may need fluids to help with swallowing and to prevent dehydration.
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