A nurse is caring for a client who is 1 day postoperative following abdominal surgery. Which of the following client statements indicates a need for further instruction?
"I will get up and walk with the physical therapy aide."
"I will do leg exercises every hour while I am awake."
"I will take off my antiembolic stockings before I go to bed."
"I will use a footstool while I sit in a chair."
The Correct Answer is C
A. Getting up and walking with the physical therapy aide promotes early mobility and is a positive statement.
B. Doing leg exercises every hour while awake helps prevent complications such as deep vein thrombosis (DVT).
C. Leaving antiembolic stockings on during sleep helps prevent DVT, so the client's statement is incorrect.
D. Using a footstool while sitting in a chair promotes proper positioning and comfort.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D,A,B,C
Explanation
Correct order: D A B C
D. Ask about the type of tobacco product used.
A. Teach the client cessation strategies.
B. Develop a cessation plan with the client.
C. Assist the client in modifying the plan if necessary.
Correct Answer is A
Explanation
A. The right task involves ensuring that the delegated task is appropriate for delegation. In this case, obtaining an oral temperature should have been the correct task; however, the AP
performed the axillary temperature, indicating a deviation from the right task.
B. Right communication involves clear and effective communication between the nurse and the assistive personnel but is not directly related to the task performed.
C. Right person involves ensuring that the task is delegated to a competent and qualified
individual. The issue in this scenario is with the task itself, not the competency of the individual.
D. Right circumstance involves ensuring that the conditions are appropriate for delegation. While the circumstance is important, the primary concern in this case is the mismatch between the task and the method of temperature measurement.
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