The health care provider has not ordered the use of a restraint for an alert patient at high risk for falling. The nurse should implement which side rail use?
Four -length rails
One-length rail
Two full-length rails
No side rails
The Correct Answer is B
A. Four-length rails.
Explanation: Four-length rails fully enclose the bed and can be considered a more restrictive measure. They may be used when a restraint order is in place, but for an alert patient without such an order, less restrictive alternatives are preferred.
B. One-length rail.
Explanation: Using one-length rails can be a less restrictive alternative when a patient is at high risk for falling. The use of one side rail allows for some protection against falls without fully restraining the patient. This approach helps maintain the patient's mobility and autonomy while still providing a safety measure.
C. Two full-length rails.
Explanation: While using two full-length rails is less restrictive than four-length rails, it is still more restrictive than using only one side rail. The goal is to balance fall prevention with the patient's autonomy.
D. No side rails.
Explanation: Using no side rails may not provide adequate protection for an alert patient at high risk for falling. While avoiding restraints is essential, implementing at least one side rail is a reasonable compromise to enhance safety without fully restricting the patient's movement.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Hospice care.
Explanation: Both Medicare Part A and Part B cover hospice care, and hospice care is not a fundamental difference between the two parts.
B. Home care services.
Explanation: Both Medicare Part A and Part B cover certain home care services. While the specific services covered may vary, home care services are not a fundamental difference between the two parts.
C. Health care setting.
Explanation: Medicare Part A and Part B cover different aspects of healthcare and are designed for different health care settings.
Medicare Part A (Hospital Insurance): Primarily covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care services. It is generally associated with institutional settings.
Medicare Part B (Medical Insurance): Covers outpatient care, preventive services, doctor visits, and some home health care services. It is more focused on services provided in non-institutional settings.
D. Invasive procedures.
Explanation: Both Medicare Part A and Part B cover various medical services, including invasive procedures. The nature of procedures covered may differ, but it is not a fundamental difference distinguishing between Part A and Part B.
Correct Answer is C
Explanation
A. This statement is not entirely accurate. While Medicaid does provide assistance to eligible individuals, its primary focus is on healthcare coverage rather than offering general monetary benefits.
B. Medicaid is more focused on providing healthcare support rather than offering a minimum level of economic support. Its primary aim is to help cover medical expenses for eligible individuals.
C. Medicaid is designed to help the states defray the expenses for the poor.
Medicaid is a joint federal and state program that assists with medical costs for people with low income, including some low-income adults, children, pregnant women, elderly adults, and people with disabilities.
D. This statement is partially correct but doesn't encompass the full scope of Medicaid. Medicaid provides healthcare coverage for low-income individuals, including the older adult and disabled populations, but it also includes other eligible groups.
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