A nurse is preparing to test a client's plantar Babinski reflex. Which of the following Instructions should the nurse give to prepare the client for this test?

"Lie down and I will stroke the bottom of your foot."

"Sit on the edge of the bed while I tap your knee."

"Place your foot in my hand and I will tap the back of your heel."

"Relax your arm across your chest and I will test your elbow extension."

Answer and Explanation

The Correct Answer is A

A.   Correct. The plantar Babinski reflex is elicited by stroking the sole of the foot along the lateral aspect, from the heel to the ball of the foot. The nurse's instruction to the client is accurate.
B.   Tapping the knee is related to the knee jerk reflex, not the Babinski reflex.
C.   Tapping the back of the heel does not elicit the plantar Babinski reflex.
D.   Testing elbow extension is unrelated to the Babinski reflex.

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Correct Answer is {"dropdown-group-1":"E","dropdown-group-2":"B"}

Explanation

When interpreting test results, particularly for an infectious disease like tuberculosis (TB), the nurse must prioritize specific infection control measures to prevent the spread of the disease.

The correct actions are:

Wear an N95 respirator mask: This mask is essential for protecting the nurse and others from inhaling airborne pathogens that the client with TB might expel.
Place the client in a room with negative air pressure: This type of room ensures that airborne contaminants do not escape into the hallway or other areas, thereby containing the infection and protecting others in the healthcare facility.

These measures are critical in managing the spread of TB and ensuring the safety of both healthcare workers and other patients.

A. Measure the client's abdominal girth daily. B. Restrict the client's sodium intake to 3 g per day. C. Keep the client's daily protein intake below 0.8 g/kg. D. Position the client supine with legs elevated.

Correct Answer is A

Explanation

A. Correct. Measuring abdominal girth daily is important to monitor for changes in ascites and fluid retention.
B. Restricting sodium intake is important for clients with ascites to manage fluid retention, but a specific limit of 3 g per day is not universally applicable.
C. Protein intake should not be significantly restricted for clients with ascites; protein is essential for maintaining adequate serum albumin levels.
D. Positioning the client supine with legs elevated might be uncomfortable and not directly related to managing ascites.

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A nurse is preparing to test a client's plantar Babinski reflex. Which of the following Instructions should the nurse give to prepare the client for this test?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse reviews the client's test results. Exhibits Complete the following sentence by using the list of options. The nurse should and

Correct Answer is {"dropdown-group-1":"E","dropdown-group-2":"B"}

Explanation

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Correct Answer is A

Explanation

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