A nurse is caring for a client who is undergoing a lumbar puncture.
Which of the following is the priority action for the nurse to take to maintain privacy for the client?
Pull the curtains around the client's bed.
Ask family members to leave the room.
Use sterile drapes to cover the client.
Close the door to the client's room.
The Correct Answer is A
Choice A rationale:
Pulling the curtains around the client’s bed ensures privacy during the procedure.
Choice B rationale:
Asking family members to leave the room might be necessary, but it’s not the priority action.
Choice C rationale:
Using sterile drapes to cover the client is important for maintaining sterility, not privacy.
Choice D rationale:
Closing the door to the client’s room can provide privacy, but pulling the curtains around the bed is a more immediate action.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B"]
Explanation
Choice A rationale:
Localized edema is a common sign of infection. The body sends extra fluid to the area as part of the inflammatory response.
Choice B rationale:
An increase in neutrophils, a type of white blood cell, is a common response to infection. Neutrophils are part of the body’s immune response and work to fight off invading bacteria.
Choice C rationale:
An increase in platelets is not typically associated with infection. Platelets are involved in blood clotting, not the immune response.
Choice D rationale:
Bradycardia, or a slow heart rate, is not typically associated with infection. Infection usually causes an increased heart rate, not a decreased one.
Choice E rationale:
An increase in RBCs is not typically associated with infection. RBCs carry oxygen around the body, but their number does not usually change in response to infection.
Correct Answer is B
Explanation
Choice A rationale:
Notifying the nurse manager is important, but it’s not the priority action.
Choice B rationale:
Monitoring the client for hypoglycemia is the priority because the nurse administered an excessive insulin dose.
Choice C rationale:
Completing an incident report is necessary, but it’s not the priority action.
Choice D rationale:
Giving the client 15 to 20 g of carbohydrate might be necessary if the client shows signs of hypoglycemia.
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