A nurse is preparing to assist a client out of bed to a wheelchair following left knee surgery. The nurse should identify that which of the following images indicates the correct placement of the wheelchair?
A
B
B
The Correct Answer is C
A. Wheelchair is on the left side, which is the postoperative knee, risking strain or injury to the healing limb during transfer. Not ideal for maximizing client safety and independence in mobility.
B: Wheelchair is placed at the head of the bed, making it impractical and unsafe for transfer. No clear pivot point, and body mechanics would be compromised for both the nurse and the client.
C. The wheelchair is positioned on the client's right side, which is the unaffected leg, allowing the client to pivot and transfer using their stronger limb. This placement minimizes strain on the left surgical knee, which reduces pain and risk of injury.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Tortuous veins: Tortuous veins indicate varicosities, which are typically a chronic condition and not an immediate sign of deep-vein thrombosis (DVT). While they can be associated with venous insufficiency, they do not require urgent reporting for DVT suspicion.
B. Calf swelling: Calf swelling, especially if unilateral, is a classic sign of DVT and suggests venous obstruction by a thrombus. This finding requires prompt reporting to prevent complications such as pulmonary embolism.
C. Bradycardia: Bradycardia is unrelated to DVT and is not an expected finding in this condition. It does not indicate thrombotic complications and does not require immediate reporting in this context.
D. Clammy skin: Clammy skin can be a nonspecific sign related to many conditions such as shock or anxiety but is not a primary indicator of DVT. It does not necessitate urgent reporting for DVT unless accompanied by other concerning signs.
Correct Answer is A
Explanation
A. Syringe: A syringe is essential for irrigating a stage 4 pressure injury to cleanse the wound thoroughly without causing trauma to the tissue. Proper irrigation helps remove debris and bacteria, promoting healing. A syringe allows controlled, gentle flushing of the wound bed, which is important in managing deep, complex wounds like stage 4 pressure injuries.
B. Tongue depressor: A tongue depressor is generally used to examine the throat and oral cavity and is not suitable for wound care. It lacks the precision and safety needed for wound cleaning or dressing application, especially for deep pressure ulcers.
C. Adhesive tape: Adhesive tape is used to secure dressings but is not a primary supply for wound care itself. In managing a stage 4 pressure injury, the priority is proper wound cleaning and dressing materials rather than just securing them, so adhesive tape is secondary.
D. Cotton-tipped applicator: Cotton-tipped applicators are commonly avoided in wound care because they can leave fibers in the wound bed and potentially cause trauma or infection. They are not recommended for cleaning or applying medication to deep pressure ulcers, where more sterile, gentle methods are needed.
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