A nurse is assisting with the ambulation of a client with the use of a gait belt, who becomes light-headed and begins to fall. Which of the following actions should the nurse take?

extend one leg and allow the client to slide down the leg to the floor.

move both feet together when the client begins to fall

wrap both arms around the client's arm and shoulders

protect the client's extremities while lowering them to the floor.

Answer and Explanation

The Correct Answer is A

A. Extend one leg and allow the client to slide down the leg to the floor.

It helps to control the fall, protects the client from injury, and allows the nurse to safely guide the client to the floor without using excessive force.

B. Move both feet together when the client begins to fall.

Keeping the feet together reduces stability and increases the risk of both the client and nurse falling.

C. Wrap both arms around the client's arm and shoulders.

This could cause injury to the client’s upper body and doesn't provide support for a safe fall.

D. Protect the client's extremities while lowering them to the floor.

While protecting extremities is important, the nurse’s primary action should be to use proper body mechanics (like extending one leg) to safely lower the client.

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Correct Answer is ["A","C","D","E"]

Explanation

A. Elevate the foot:

Elevation helps reduce swelling by promoting venous return.

B. Encourage range-of-motion exercises of the foot:

Movement should be limited until the injury is evaluated to prevent further damage.

C. Provide the client with a light snack:

This can be appropriate if there are no contraindications, especially if the client has been waiting and is hungry. It doesn’t worsen the injury and supports comfort.

D. Apply a compression bandage:

Compression helps reduce swelling and provides support to the injured joint.

E. Apply ice to the ankle:

Ice reduces inflammation and helps with pain management during the acute phase of a soft-tissue injury.

A. "I have a set of my brother's crutches in my basement that I can also use." B. "I will keep spare crutch tips handy." C. "I will bear the weight of my body on my hands." D. "I will inspect my crutches every day for signs of wear."

Correct Answer is A

Explanation

A. "I have a set of my brother's crutches in my basement that I can also use.

Crutches must be individually fitted to the user’s height and arm length to prevent nerve injury and ensure safe mobility. Using another person’s crutches is unsafe.

B. "I will keep spare crutch tips handy."

Crutch tips can wear out or become slippery. Keeping extras on hand is a good safety measure.

C. "I will bear the weight of my body on my hands."

Weight should be borne through the hands and not the underarms to avoid brachial nerve damage (crutch palsy).

D. "I will inspect my crutches every day for signs of wear."

Daily inspection of crutch tips and padding helps ensure safety and durability.

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A nurse is assisting with the ambulation of a client with the use of a gait belt, who becomes light-headed and begins to fall. Which of the following actions should the nurse take?

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Naxlex Comprehensive Predictor Exams

A nurse in an urgent care center is caring for a client who fell and injured her ankle. The ankle appears swollen and ecchymotic. While the client waits for the x-ray technician, which of the following actions should the nurse take? (Select all that apply.)

Correct Answer is ["A","C","D","E"]

Explanation

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Correct Answer is A

Explanation

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