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

Answer and Explanation

The Correct Answer is C

A. If the client is independent, give them privacy to bathe, if they prefer. If leaving a client unattended, check on them every 5 minutes or more frequently as needed. Ensure the client knows how to use safety items such as shower chairs and grab bars.

B. Adding bath oil to the water after the client is in the tub can create a slippery surface, increasing the risk of falls. Bath oil should be added before the client enters the tub or avoided if there is a risk of slipping.

C. Draining the tub water before the client gets out helps prevent slips and falls that can occur if the client attempts to exit the tub while the water is still present. This practice enhances safety by reducing the risk of accidents.

D. Tub baths or very warm showers can lead to a person feeling faint, nauseous, or tired. Baths should not last longer than 20 minutes and should be discontinued at the first sign of patient discomfort, weakness, or complaints of feeling faint.

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Correct Answer is A

Explanation

Stressors can be categorized as external or internal. External stressors are factors or events in the environment that can cause stress.

In this case, the recent move to a new city is an external stressor because it is an event that has occurred outside of the client and is influencing their current state of stress. Moving to a new city can bring about significant changes and challenges, such as adjusting to a new environment, finding new social connections, and adapting to unfamiliar surroundings.

Feeling depressed is an internal stressor because it relates to the client's emotional state or mental health condition. Depression can be caused by various factors, such as biochemical imbalances, life circumstances, or genetic predispositions.

Lack of nutritional knowledge: This is an internal stressor because it refers to the client's lack of knowledge or awareness regarding nutrition. While the lack of nutritional knowledge can contribute to stress, it is an internal factor that can be addressed through education and learning.

While recurring urinary tract infections can be stressful for the client, they are considered an internal stressor because they involve a physical condition or health issue within the client's body. Addressing and managing the infections would involve medical interventions and possibly lifestyle modifications.

A. Temporary memory loss B. Neck pain C. Voice alteration D. Tingling of the scalp

Correct Answer is A

Explanation

ECT can cause temporary memory loss, particularly for events occurring around the time of the treatment. The client may experience difficulty remembering details of recent events or conversations. This effect is usually temporary and improves over time.

Neck pain is not a typical adverse reaction to ECT. The procedure itself does not involve manipulation or strain on the neck, and significant neck pain following ECT would be unusual. However, it is essential for the nurse to assess and address any discomfort or pain the client experiences after the procedure.

Voice alteration is not a known adverse reaction to ECT. ECT primarily affects the brain and does not directly impact the vocal cords or voice production.

Tingling of the scalp is not a common adverse reaction to ECT. During the procedure, the client receives a brief electrical stimulus, usually applied through electrodes placed on the scalp. Sensations experienced during the procedure are typically related to the electrical stimulation and are transient.

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A nurse is assisting a client who requests to take a tub bath. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

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