Which nursing action should be implemented first when assisting the patient to a lateral position for placement of a bedpan?

Move the patient to the side of the bed.

Place the patient's arm over the chest.

Raise the bed to a proper working height.

Turn the patient using the draw sheet.

Answer and Explanation

The Correct Answer is A

Choice A rationale:

Moving the patient to the side of the bed is the first nursing action that should be implemented when assisting the patient to a lateral position for placement of a bedpan. This step ensures proper body mechanics and patient safety during the transfer. The nurse should assist the patient to the edge of the bed, farthest from them, and then help the patient turn onto their side, facing away from the nurse. This position facilitates the placement of the bedpan and maintains the patient's dignity and comfort.

Choice B rationale:

Placing the patient's arm over the chest is a subsequent step after moving the patient to the side of the bed. After the patient is in the lateral position, the nurse should assist in placing the uppermost arm comfortably over the chest to maintain balance and stability during the bedpan placement.

Choice C rationale:

Raising the bed to a proper working height is essential for the nurse's ergonomic safety and comfort during the procedure. However, it is not the first step in assisting the patient to a lateral position. The bed should be at a height that allows the nurse to work comfortably without straining their back, but this step comes after the patient has been safely positioned on their side.

Choice D rationale:

Turning the patient using the draw sheet is another appropriate technique for repositioning patients, especially when they are unable to assist with the movement. However, in this scenario, the nurse needs to assist the patient to a lateral position for the bedpan placement, which involves different techniques. Using a draw sheet might be necessary in other situations, such as when turning a bedridden patient in bed, but it is not the first action for placing a bedpan.

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Correct Answer is C

Explanation

Choice A rationale:

Calling the physician to request an antianxiety medication might address the client's anxiety, but it does not directly respond to the client's existential question about God punishing them.

Choice B rationale:

Sharing personal religious beliefs with the client can be inappropriate and may not align with the client's beliefs, potentially causing discomfort or offense.

Choice C rationale:

Sitting quietly with the client and offering caring touch demonstrates empathy, compassion, and presence. It allows the nurse to provide emotional support without imposing personal beliefs or judgments. This approach encourages the client to express their feelings and facilitates a therapeutic nurse-client relationship.

Choice D rationale:

Advising the client about a good worship center nearby does not directly address the client's existential question or provide emotional support. Additionally, the client may not be interested in religious activities at this moment.

A. Provide non-slip footwear to patients during their stay. B. Keep the bed in high position to allow for ease of care. C. Institute a policy requiring a sitter for all patients above the age of 60. D. Avoid using a night light in the room to promote sleep.

Correct Answer is C

Explanation

Choice A rationale:

Providing non-slip footwear to patients during their stay is a good preventive measure, but it only addresses the risk of falls related to slippery floors. It does not address the overall fall risk, especially for elderly patients who may need constant supervision and assistance.

Choice B rationale:

Keeping the bed in a high position for ease of care might seem practical, but it increases the risk of falls when the patient attempts to get out of bed. Lowering the bed reduces the risk of injury if a fall occurs and is a more appropriate intervention.

Choice C rationale:

Instituting a policy requiring a sitter for all patients above the age of 60 is the best option among the choices provided. Elderly patients are at a higher risk of falls due to various factors such as weakened muscles, balance issues, and medication side effects. Having a dedicated sitter ensures constant supervision, timely assistance, and prompt intervention if the patient attempts to get out of bed, significantly reducing the risk of falls.

Choice D rationale:

Avoiding the use of a night light in the room to promote sleep is not a recommended intervention. While promoting sleep is essential for overall patient well-being, patient safety should always be the priority. Providing adequate lighting, especially at night, reduces the risk of falls and other accidents.

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Which nursing action should be implemented first when assisting the patient to a lateral position for placement of a bedpan?

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