A nurse working the night shift is caring for an older adult client who has dementia and is at risk for falls. Which of the following actions should the nurse take?
Apply a motion sensor mat to the client's bed.
Move the overbed table away from the bed.
Raise all four side rails while the client is in bed.
Leave the television on in the client's room.
The Correct Answer is A
The correct answer is choice A, apply a motion sensor mat to the client's bed. This is an effective intervention to monitor the client's movements and prevent falls. The mat is placed under the bed sheet and will sound an alarm if the client tries to get out of bed.
- Moving the overbed table away from the bed is not the correct answer because it does not prevent falls.
- Raising all four side rails while the client is in bed is not the correct answer because it can cause the client to feel trapped and can lead to injuries if they try to climb over the rails.
- Leaving the television on in the client's room is not the correct answer because it can be distracting and interfere with the client's sleep.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Clients with a left-sided stroke will have neurological deficits on the right side of the body, including paralysis or weakness. Impaired speech, language, and cognition are also possible. Blood pressure, temperature, and laboratory results may be affected by the stroke, but they are not specific to a left-sided stroke.
Option A, "Blood pressure," is incorrect because it may be affected by the stroke, but it is not specific to a left-sided stroke.
Option B, "Temperature," is incorrect because it may be affected by the stroke, but it is not specific to a left-sided stroke.
Option D, "Laboratory results," is incorrect because they may be affected by the stroke, but they are not specific to a left-sided stroke.
Correct Answer is B
Explanation
The correct answer is choice B: Store opened insulin vials at room temperature for up to 4 weeks.
Choice B rationale: Opened insulin vials can be stored at room temperature (59°F to 86°F or 15°C to 30°C) for up to 4 weeks. After this period, the insulin may lose potency, and a new vial should be used.
Choice A rationale: Regular insulin is short-acting, and its peak effect occurs 2 to 3 hours after administration. Eating a snack 6 hours after insulin administration may not be necessary as the insulin would have already reached its peak effect, and blood glucose levels should be monitored accordingly.
Choice C rationale: Warming the insulin vial to dissolve crystals is not recommended. Insulin should be inspected before use, and if crystals or clumps are present, it should be discarded as this could indicate that the insulin has lost its effectiveness.
Choice D rationale: Unopened insulin vials should be stored in the refrigerator (36°F to 46°F or 2°C to 8°C) and should not be frozen. Freezing can cause insulin to lose potency or become ineffective. Once opened, insulin vials can be stored at room temperature for up to 4 weeks, as mentioned in choice B.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.