A nurse is assisting a client who requests to take a tub bath. Which of the following actions should the nurse take?
Check on the client every 10 min during the bath.
Add bath oil to the water after the client gets into the tub.
Drain the tub water before the client gets out.
Allow the client to remain in the bath for 30 min.
The Correct Answer is C
Answer is: Drain the tub water before the client gets out.
Explanation: This is the correct answer because it reduces the risk of slipping and falling for the client, especially if they have limited mobility or balance problems. The other options are incorrect because:
- Checking on the client every 10 min during the bath is not enough to ensure their safety and comfort. The nurse should check on them more frequently, such as every 5 to 10 minutes, depending on their needs and preferences.
- Adding bath oil to the water after the client gets into the tub is not a good idea because it can make the water slippery and increase the risk of falling. The nurse should add bath oil to the water before the client gets into the tub, or use a non-slip mat or shower chair.
- Allowing the client to remain in the bath for 30 min is too long and can cause dehydration, hypothermia, or skin irritation. The nurse should instruct the client to remain in the tub for no longer than 20 min, unless otherwise ordered by a physician.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Incorrect. Human papillomavirus (HPV. is a common sexually transmitted infection, but it is not typically a reportable infection to the state health department.
B. Correct. Neisseria gonorrhoeae is a reportable sexually transmitted infection, and healthcare providers are required to report cases to the state health department for tracking and intervention purposes.
C. Incorrect. Impetigo contagiosa is a bacterial skin infection, but it is not typically a reportable infection to the state health department.
D. Incorrect. Sarcoptes scabiei is the parasite that causes scabies, a skin condition, but it is not typically a reportable infection to the state health department.
Correct Answer is ["A","B","F"]
Explanation
A. Oxygen saturation level: The client is restless, not following commands, and has labored respirations with crackles and wheezes in the breath sounds. Monitoring the oxygen saturation level is essential to assess the client's respiratory status and oxygenation.
B. Tremors: The client has tremors in their hands. Considering the client's history of Parkinson's disease, changes in tremors should be monitored and addressed promptly.
C. The immediate concern is addressing the respiratory distress.
D. Heart rate may also be monitored, but it's not as critical in this context.
E. Chronic health conditions are relevant for the overall care plan, but they do not require immediate intervention as compared to respiratory and tremor issues.
F. Respiratory rate: The client has labored respirations and abnormal breath sounds (crackles and wheezes). Monitoring the respiratory rate is important to evaluate the client's breathing pattern and respiratory distress.
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