The practical nurse (PN) observes an unlicensed assistive personnel (UAP) bathing a bedfast client with the bed in the high fowlers position. Which action should the PN take?

Assume care of the client immediately.

Remain in the room to supervise the UAP.

Instruct the UAP to lower the bed for safety.

Determine if the UAP would like assistance.

Answer and Explanation

The Correct Answer is C

The correct answer is choice C: Instruct the UAP to lower the bed for safety.

Choice C rationale: When bathing a bedfast client, the bed should be in a flat or low position to reduce the risk of the client sliding down, falling, or experiencing discomfort or injury. By instructing the UAP to lower the bed, the PN ensures client safety during the bathing process.

Choice A rationale: Assuming care of the client immediately might be unnecessary. The PN should first address the safety concern and then determine if additional intervention is needed.

Choice B rationale: While supervising the UAP may be appropriate in certain situations, the priority in this case is to address the immediate safety concern by instructing the UAP to lower the bed. The PN can then decide if supervision or assistance is required.

Choice D rationale: Determining if the UAP would like assistance is considerate, but it is not the priority in this situation. Ensuring client safety by lowering the bed should be addressed first. The PN can then assess whether the UAP needs any help or guidance.

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Correct Answer is B

Explanation

Choice A rationale:

Assessment of tobacco use geared toward adolescents is an important topic, but it may not directly address the immediate concerns related to the increase in suicides in the community. While substance abuse can be a risk factor for mental health issues, focusing on stress self-management techniques may be more relevant in this context as it can help adolescents cope with various stressors and emotions that could contribute to suicidal thoughts.

Choice C rationale:

Showing statistics on suicide rates may be informative but may not be the most engaging and effective approach to teaching adolescents about mental health. Statistics alone may not provide them with practical tools and strategies to manage their mental well-being.

Choice D rationale:

Providing handouts for local substance abuse treatment centers is important if substance abuse is a concern, but it may not address the broader issue of mental health and suicide prevention. The primary focus should be on teaching adolescents how to manage stress and emotions in a healthy way, as this can be a preventive measure for various mental health issues, including suicidal thoughts.

A. A bedside commode is positioned near the bed. B. A full pitcher of water is on the bedside table. C. The client is lying in a supine position in bed. D. A saline lock is present in the right forearm. E. A low sodium diet tray was brought to the room.

Correct Answer is ["C","E"]

Explanation

Choice A rationale:

A bedside commode is positioned near the bed. Positioning a bedside commode near the bed is appropriate for a client with heart failure and COPD who may have mobility issues or difficulty walking to the bathroom. It promotes safety and convenience for the client.

Choice B rationale:

A full pitcher of water is on the bedside table. While it's essential to keep clients with heart failure adequately hydrated, having a full pitcher of water within easy reach might encourage excessive fluid intake, which can exacerbate heart failure symptoms. However, this choice is not an immediate risk requiring intervention.

Choice C rationale:

The client is lying in a supine position in bed. A client with heart failure and COPD should not be lying in a supine position because it can exacerbate respiratory distress and increase the workload of the heart. This is an observation that requires immediate intervention, such as repositioning the client to an upright or semi-fowler's position.

Choice D rationale:

A saline lock is present in the right forearm. The presence of a saline lock is a standard precaution in a hospitalized client and does not require immediate intervention unless there are specific issues with it, such as signs of infection or dislodgement. It does not pose an immediate harm to the client.

Choice E rationale:

A low sodium diet tray was brought to the room. A low sodium diet is crucial for managing heart failure because excessive sodium intake can lead to fluid retention and exacerbate symptoms. Ensuring that the client follows the prescribed diet is essential for their well-being, and any deviations may require immediate intervention.

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The practical nurse (PN) observes an unlicensed assistive personnel (UAP) bathing a bedfast client with the bed in the high fowlers position. Which action should the PN take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

After an increase in the number of suicides in a community, the nurse is developing a class for adolescents about mental health.Which type of activity should the nurse include in the teaching?

Correct Answer is B

Explanation

A client is admitted with an exacerbation of heart failure secondary to chronic obstructive pulmonary disease (COPD). Which observation(s) by the nurse require immediate intervention to reduce the likelihood of harm to this client? (Select all that apply.).

Correct Answer is ["C","E"]

Explanation

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