The nurse is delegating ambulation for a client to an experienced Patient Care Technician (PCT).Which teaching will the nurse provide to the PCT? (Select all that apply.)
“Please let me know how the client does after each ambulation."
"Ambulate the client every four hours."
“Come and get me for lunch.”
“Be certain to use a gait belt when performing this activity."
“Each ambulation should last 10 minutes"
Correct Answer : A,D,E
The teaching that the nurse will provide to the Patient Care Technician (PCT) when delegating ambulation for a client includes:
● "Please let me know how the client does after each ambulation": This instruction ensures that the PCT communicates any relevant information or changes observed during or after the ambulation, allowing the nurse to stay informed about the client's condition.
● "Be certain to use a gait belt when performing this activity": Using a gait belt is an important safety measure during ambulation. It helps provide support and stability for the client and allows the PCT to maintain control and assist in case the client becomes unsteady or falls.
● "Each ambulation should last 10 minutes": Providing a specific time frame for the ambulation helps guide the PCT in determining the duration of the activity. This ensures consistency in the care provided and allows for proper scheduling of ambulation throughout the day.
The other options provided ("Ambulate the client every four hours," "Come and get me for lunch") do not pertain to specific instructions or teaching related to the delegated ambulation task. The frequency of ambulation and the PCT's lunch break are not relevant to the teaching for this specific task.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
An increased serum potassium level, also known as hyperkalemia, can have adverse effects on the electrical conduction of the heart, potentially leading to life-threatening cardiac dysrhythmias. Therefore, it is crucial to assess the patient's pulse rate and rhythm promptly to identify any abnormal cardiac activity.
Assessing the oxygen saturation (oxygen stats), respiratory rate and depth, and deep tendon reflexes are also important assessments, but they are not the priority in this case. Hyperkalemia primarily affects cardiac function, and prompt identification of any potential cardiac rhythm disturbances is essential to prevent further harm.
Correct Answer is B
Explanation
Gentamicin is an antibiotic that is usually administered via IV infusion. The peak level is the highest concentration of the medication in the bloodstream, and it is important to monitor it to ensure therapeutic levels are achieved without reaching toxic levels.
Drawing the peak level 30 minutes after the infusion is complete allows enough time for the medication to distribute throughout the body and reach its peak concentration. This timing provides an accurate representation of the highest drug concentration in the bloodstream. 30 minutes before starting the infusion: Drawing the peak level before starting the infusion would not accurately reflect the peak concentration of the medication in the bloodstream. Immediately before the next dose of Gentamicin: Drawing the peak level immediately before the next dose would not provide an accurate assessment of the highest drug concentration, as the levels would have started to decrease due to elimination.
1 hour after infusion is complete: Waiting for 1 hour after the infusion is complete may result in missing the actual peak concentration of the medication in the bloodstream, as it may have already started to decline.
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