The nurse is demonstrating correct transfer procedures to the unlicensed assistive personnel (UAP) working on a rehabilitation unit. The UAP asks the nurse how to safely move a physically disabled client from the wheelchair to a bed. Which action should the nurse recommend?

Hold the client at arm's length while transferring to better distribute the body weight.

Place the client's locked wheelchair on the client's strong side next to the bed.

Pull the client into position by reaching from the opposite side of the bed.

Apply a gait belt around the client's waist once a standing position has been assumed.

Answer and Explanation

The Correct Answer is B

A. Hold the client at arm's length while transferring to better distribute the body weight: Holding the client at arm's length is not recommended as it does not provide adequate support. The caregiver should be close to the client to maintain control to ensure safe transfer.

B. Place the client's locked wheelchair on the client's strong side next to the bed: Positioning the wheelchair on the client’s strong side provides support and stability during the transfer, allowing the caregiver to assist effectively while ensuring the client’s safety.

C. Pull the client into position by reaching from the opposite side of the bed: Reaching from the opposite side of the bed can cause strain on the caregiver's back and may increase the risk of injury. It is safer to stay close to the client during transfers to minimize physical strain.

D. Apply a gait belt around the client's waist once a standing position has been assumed: The gait belt should be applied before the client assumes a standing position. This ensures proper support and control during the transfer. Waiting until standing could cause instability.

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Correct Answer is ["A","C","D"]

Explanation

Rationale for correct findings:

Fasting 1-hour glucose screen: 164 mg/dL (9.1 mmol/L): The fasting glucose of 164 mg/dL is elevated, indicating impaired glucose metabolism, which suggests the possibility of gestational diabetes.
3-hour glucose tolerance test: Fasting blood sugar 168 mg/dL (9.3 mmol/L): The fasting blood sugar of 168 mg/dL is above the normal threshold of 140 mg/dL, reinforcing the suspicion of gestational diabetes.
2-hour postprandial glucose: 220 mg/dL (12.2 mmol/L): A postprandial glucose level of 220 mg/dL is significantly above the normal limit of 140 mg/dL, further indicating gestational diabetes.
Fourth child with macrosomia: 9 pounds (4.08 kg) at 41 weeks gestation: Macrosomia is often associated with gestational diabetes. The fourth child weighing 9 pounds suggests the possibility of undiagnosed gestational diabetes during the previous pregnancy, which could be recurring in the current pregnancy.

Rationale for incorrect Findings:

Client is at 28 weeks and has been receiving prenatal care since 8 weeks gestation: The client’s consistent prenatal care since 8 weeks indicates early and regular monitoring, reducing the likelihood of other major complications.

A. "Haven't you been feeding according to recommended daily allowances for children?" B. "Does your child seem mentally slower than his peers also?" C. "You should not worry about the growth tables. They are only averages for children." D. "The smaller size is probably due to the heart disease."

Correct Answer is D

Explanation

A. "Haven't you been feeding according to recommended daily allowances for children?": This response implies blame and lacks sensitivity. It doesn't acknowledge the child’s underlying medical condition that may affect growth.

B. "Does your child seem mentally slower than his peers also?": Intellectual development is unrelated to height/weight percentile in children with congenital heart disease unless there are neurological complications, which haven't been indicated.

C. "You should not worry about the growth tables. They are only averages for children.": While growth charts are averages, they are clinically significant, especially for identifying underdevelopment in children with chronic illnesses.

D. "The smaller size is probably due to the heart disease.": Chronic hypoxia and increased metabolic demands in congenital heart disease often contribute to poor weight gain and growth delay, making this the most informative and empathetic response.

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The nurse is demonstrating correct transfer procedures to the unlicensed assistive personnel (UAP) working on a rehabilitation unit. The UAP asks the nurse how to safely move a physically disabled client from the wheelchair to a bed. Which action should the nurse recommend?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is ["A","C","D"]

Explanation

A pre-school age child with a congenital heart defect is brought to the clinic by the parent because of a fever and an earache. During the assessment, the parent asks the nurse why the child is at the 5th percentile for weight and height for age. Which response is best for the nurse to provide?

Correct Answer is D

Explanation

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