A nurse is assisting a client during ambulation when the client begins to fall. Which of the following actions should the nurse take?

Lean the client toward the wall.

Assume a narrow base of support.

Lower the client to the floor.

Provide support by holding the client's arm

Answer and Explanation

The Correct Answer is C

Choice A rationale: Leaning the client toward the wall may not provide sufficient support and could lead to a fall.
Choice B rationale: Assuming a narrow base of support does not provide adequate stability when a client is falling.
Choice C rationale: Lowering the client to the floor is a safety measure to prevent injury during a fall. It reduces the distance of the fall and minimizes the risk of injury.
Choice D rationale: Providing support by holding the client's arm may not be sufficient to prevent a fall. Lowering the client to the floor is a safer option.

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Correct Answer is C

Explanation

Choice A rationale: Percussion is typically performed after auscultation in the abdominal assessment sequence.
Choice B rationale: Deep palpation is usually performed after light palpation in the abdominal assessment sequence.
Choice C rationale: Auscultation is the next step in the abdominal assessment sequence after inspection. Assessing bowel sounds is crucial before moving on to other assessment techniques.
Choice D rationale: Light palpation is often the initial step in the abdominal assessment sequence, followed by auscultation.

A. "I should use my axilla to bear body weight." B. "I should keep my elbows extended." C. "When getting up out of the chair, I should extend my uninjured leg." D. "To climb stairs, I should place weight on my unaffected leg first."

Correct Answer is D

Explanation

Choice A rationale: Using the axilla to bear body weight can lead to nerve damage and is not a proper crutch technique.
Choice B rationale: Keeping the elbows extended can lead to discomfort and poor crutch control. The elbows should be slightly flexed.
Choice C rationale: When getting up from a chair, extending the uninjured leg first is not the correct technique. The patient should keep the injured leg extended for stability.
Choice D rationale: Placing weight on the unaffected leg first when climbing stairs is the correct technique, allowing for better balance and stability.

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A nurse is assisting a client during ambulation when the client begins to fall. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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Correct Answer is D

Explanation

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