A nurse is moving a client up in bed with the assistance of a second nurse. Which of the following actions should the nurse take?
Stand facing the center of the bed at the client's side.
Place feet apart with the foot nearest the head of the client's bed in front of the other foot
Keep knees and hips straight while bending at the waist toward the client
Encourage the client to keep their legs straight and remain still.
The Correct Answer is B
A: Standing facing the center of the bed at the client's side is not the most stable position for moving a client, as it does not provide a wide base of support.
B: Placing feet apart with one foot in front of the other provides a wide base of support and allows the nurse to use their body weight to assist in the movement, making this the correct action.
C: Keeping knees and hips straight while bending at the waist toward the client can lead to back strain and does not utilize the stronger leg muscles, making it an incorrect action.
D: Encouraging the client to keep their legs straight and remain still may be helpful, but it does not directly involve the nurse's actions in moving the client, so it is not the correct answer to this question.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Restrict the client's visitors to the immediate family: While tuberculosis is a communicable disease, restricting visitors to the immediate family is not a standard precautionary measure. Visitors should be educated about infection control measures and individuals with active tuberculosis
may need to wear masks in certain situations.
B. Assign the client to a negative pressure airflow room: Correct. Clients with active tuberculosis should be placed in a negative pressure airflow room to prevent the spread of infectious airborne particles to other areas of the facility. Negative pressure ensures that air from the room does not flow to other parts of the facility.
C. Discard personal protective equipment outside the client's room: Personal protective equipment (PPE) should be removed and discarded according to facility policy, which often includes removing PPE inside the client's room and properly disposing of it afterward. The nurse should follow standard precautions for infection control.
D. Have the client wear a HEPA mask during transportation throughout the facility: While wearing a HEPA mask may be necessary for clients with tuberculosis, it is not related to the initial admission process. Clients with active tuberculosis may be asked to wear a HEPA mask during transportation when they need to leave their negative pressure room.
Correct Answer is C
Explanation
A: Asking the client why they are angry may come across as confrontational and defensive, potentially escalating the situation. It does not promote open communication or therapeutic rapport.
B: Sharing personal information about diabetes running in the nurse's family is not relevant to the client's feelings or concerns and may not be helpful in addressing the client's anger.
C: Correct. Acknowledging the client's feelings of anger and offering to sit down and talk provides an opportunity for therapeutic communication. This response demonstrates empathy and a willingness to listen and address the client's concerns about insulin therapy.
D: While it is true that insulin therapy can help reduce the risk of complications in type 2 diabetes, this response may come across as dismissive of the client's feelings and concerns. It does not address the emotional aspect of the client's anger.
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