The nurse is teaching the unlicensed assistive personnel (UAP) about safety when caring for clients with limited movement. Which action by the UAP indicates to the nurse that the UAP understands the information?

Consult the posted mobility algorithm for client transfers.

Keep the feet together and bend at the waist when lifting.

Use a pulling motion when transferring and moving a client.

Avoid lifting more than 45 pounds (18 kg) independently.

Answer and Explanation

The Correct Answer is A

A. Consult the posted mobility algorithm for client transfers: Mobility algorithms provide structured guidance to safely assist clients with varying degrees of mobility. Referring to these algorithms ensures that transfers are done safely using appropriate equipment or assistance based on the client’s needs.

B. Keep the feet together and bend at the waist when lifting: This action increases the risk of back injury due to poor body mechanics. Proper lifting technique involves bending at the knees and keeping feet shoulder-width apart for better stability and spinal alignment.

C. Use a pulling motion when transferring and moving a client: Pulling can strain the back and shoulders of the caregiver and may cause harm to the client. A pushing motion is safer and allows better control during movement or repositioning.

D. Avoid lifting more than 45 pounds (18 kg) independently: While avoiding heavy lifting is important, the standard maximum safe lifting weight varies and should be guided by facility policy and ergonomic recommendations.

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Correct Answer is A

Explanation

A. Bend at the knees to maintain a low center of gravity: Bending at the knees allows the nurse to use the strong muscles of the legs instead of the back, promoting proper body mechanics and reducing the risk of injury during lifting.

B. Ask the client to place hands on the nurse's shoulders: This is unsafe, as it may cause the client to pull the nurse off balance. Clients should be instructed to push off stable surfaces, such as the armrests of the wheelchair.

C. Stand with feet 3 inches (7.6 cm) apart for balance: A 3-inch stance does not provide adequate support. Feet should be about shoulder-width apart (usually 12–18 inches) to maintain a stable base during lifting or transferring.

D. Position self at the back of wheelchair with wheels locked: While locking the wheels is correct, standing behind the wheelchair does not assist the client in rising. The nurse should be in front or to the side to offer support during the transfer.

A. Offer assurance that this particular immunization is less painful than imagined. B. Use distraction to redirect the client's attention while the nurse gives the injection. C. Review the importance of receiving the immunization as a protection from disease. D. Invite the client to use the syringe on a dummy before receiving the immunization.

Correct Answer is B

Explanation

A. Offer assurance that this particular immunization is less painful than imagined: Minimizing the client’s fear may come across as dismissive and does not address the adolescent’s expressed concern about pain, which may increase anxiety rather than reduce it.

B. Use distraction to redirect the client's attention while the nurse gives the injection: Distraction techniques are effective in reducing perceived pain and anxiety during injections. Shifting the client’s focus away from the procedure helps manage the emotional response and improves the overall experience.

C. Review the importance of receiving the immunization as a protection from disease: Providing education is important, but focusing solely on the rationale does not address the immediate emotional distress related to fear of pain. It may seem unempathetic in the moment.

D. Invite the client to use the syringe on a dummy before receiving the immunization: This action might heighten the adolescent's anxiety by drawing more attention to the needle and procedure. It is not a standard or effective strategy for managing fear of injections.

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The nurse is teaching the unlicensed assistive personnel (UAP) about safety when caring for clients with limited movement. Which action by the UAP indicates to the nurse that the UAP understands the information?

Nursing Test Bank

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