Which nursing intervention is appropriate for preventing falls in a hospitalized patient with impaired mobility?
Providing a clutter-free environment with clear pathways.
Using bed rails to restrict patient movement.
Administering sedatives to promote restfulness.
Leaving the patient unattended during ambulation.
The Correct Answer is A
Providing a clutter-free environment with clear pathways reduces the risk of falls and promotes a safe ambulatory environment for patients with impaired mobility.
Incorrect choices:
b. Bed rails are not recommended as a fall prevention measure due to the potential for entrapment and other associated risks. They should only be used when necessary and based on an individualized assessment.
c. Administering sedatives can increase the risk of falls by causing drowsiness and impaired cognition. It is not a suitable fall prevention intervention.
d. Leaving the patient unattended during ambulation increases the risk of falls. Patients with impaired mobility should not be left unattended.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Offering fluids at room temperature can enhance the patient's comfort and promote adequate hydration in immobile patients.
Incorrect choices:
b. Limiting fluid intake to prevent incontinence is not appropriate as it can lead to dehydration. Adequate hydration should be maintained, and measures to manage incontinence should be implemented separately.
c. Providing a straw for easier drinking can facilitate fluid intake, but it may not be suitable for all patients or situations. Individualized assessment and patient preference should be considered.
d. Continuous intravenous fluids may not be necessary for all immobile patients and should be based on specific indications determined by the healthcare provider. Oral intake should be encouraged unless contraindicated.
Correct Answer is A
Explanation
Performing frequent and thorough skin assessments is essential for identifying early signs of pressure ulcers and implementing appropriate preventive measures in patients with limited mobility.
Incorrect choices:
b. Applying petroleum jelly to vulnerable areas may create a barrier but does not address the underlying issue of pressure and does not substitute for regular skin assessments and preventive measures.
c. Placing the patient on an air mattress can provide pressure redistribution, but it should be used based on individualized assessment and healthcare provider recommendations. Skin assessments remain essential.
d. Encouraging the patient to sit for prolonged periods increases the risk of pressure ulcers. Adequate repositioning and regular mobilization should be prioritized to prevent skin breakdown.
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