A nurse on a medical unit is teaching a group of assistive personnel about handling clients’ bed linens safely. Which of the following instructions should the nurse include?

Return any fresh linen not used for a client to the linen supply:

Tie linen bags securely at the top.

Fili linen bags with as much soiled linen as possible:

Use double bagging to remove soiled linen from the client's room.

Answer and Explanation

The Correct Answer is B

A) Return any fresh linen not used for a client to the linen supply: Fresh linen that has been placed on a client’s bed but not used should not be returned to the linen supply. This is to prevent cross-contamination. Once linen is brought into a patient’s room, it should be considered contaminated, even if it was not used, and should be discarded properly.

B) Tie linen bags securely at the top: This is the correct action. When disposing of soiled linens, tying the linen bag securely helps to prevent the spread of pathogens and minimizes the risk of contamination. It also keeps the environment clean and safe for both staff and patients.

C) Fill linen bags with as much soiled linen as possible: Linen bags should not be overfilled. Overfilling bags can make them difficult to handle and can increase the risk of exposure to contaminants. Bags should be filled to a safe and manageable level to ensure proper handling and safety when transporting soiled linens.

D) Use double bagging to remove soiled linen from the client's room: Double bagging is typically not necessary unless there is a significant risk of contamination, such as with highly infectious material. Standard practice is to use a single, securely tied bag. Double bagging can create unnecessary waste and complicate disposal procedures unless specifically indicated by the situation or facility protocols.

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Correct Answer is D

Explanation

A) Socioeconomic factors:
Socioeconomic factors, such as income, education, and employment status, are considered external variables that influence a patient's health. These factors impact access to resources and healthcare, but they are not internal variables. Internal factors relate to personal perceptions, behaviors, and beliefs that the patient has regarding their health.

B) Family practices:
Family practices also fall under external variables. These include the health behaviors, habits, and routines practiced by the family, which can influence a patient’s health but are not internal to the individual. The nurse should assess how family practices affect health but not as internal variables.

C) Cultural background:
Cultural background is another external variable that can influence health practices, beliefs, and behaviors. It shapes how patients perceive illness, health care, and healing. While important to assess for understanding a patient's worldview, it does not fall under the category of internal variables.

D) Perception of functioning:
Perception of functioning is an internal variable because it reflects how the patient views their own health status and capabilities. This includes their sense of well-being, physical limitations, and emotional health. A patient’s perception of their functioning can directly impact their decision-making and actions related to their health, and it is essential for the nurse to assess this to guide care effectively.

A. Slide the patient into the new position B. Place the patient in a 30 degree supine position. C. utilize a transfer device to lift the patient. D. Elevate the head of the bed 45 degrees

Correct Answer is C

Explanation

A) Slide the patient into the new position: Sliding a patient when repositioning can create shear forces on the skin, which may contribute to skin damage. Shearing can occur when the skin sticks to the surface while the underlying tissues move, leading to increased risk of pressure ulcers. Therefore, sliding is not considered the most effective or safest way to reposition a patient at risk for skin impairment.

B) Place the patient in a 30-degree supine position: Placing the patient in a 30-degree supine position is a good method for reducing pressure on bony prominences and minimizing the risk of pressure injuries. However, while this position is helpful for preventing skin breakdown, it does not address the method of repositioning, which is what is being asked in this question.
C) Utilize a transfer device to lift the patient: Using a transfer device, such as a lift or slide sheet, to lift the patient is the best method for repositioning. This technique helps to reduce friction and shear forces on the skin, providing a safer and more effective way to move the patient without causing damage. Transfer devices also allow for a smoother repositioning, minimizing the risk of skin impairment.

D) Elevate the head of the bed 45 degrees: Elevating the head of the bed to 45 degrees can increase the risk of pressure injuries, especially if the patient is immobile and cannot relieve pressure themselves. This position can also contribute to shear forces as the patient slides downward. It may be appropriate in certain clinical situations, but it does not directly address the method of repositioning.

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A nurse on a medical unit is teaching a group of assistive personnel about handling clients’ bed linens safely. Which of the following instructions should the nurse include?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

The nurse is caring for a patient who is immobile and is at risk for skin impairment. The plan of care includes turning the patient. Which is the best method for repositioning the patient?

Correct Answer is C

Explanation

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