A nurse is providing an in-service about repositioning clients and the use of lift pads for immobile clients. What is the rationale for placing lift pads under an immobile client?

The pads will keep the staff from workplace injuries such as a pulled muscle.

The pads will absorb any urinary incontinence and contain stool.

The pads will help prevent friction and shearing when repositioning the client.

The pads will prevent the client from being diaphoretic.

Answer and Explanation

The Correct Answer is C

Choice A reason: While lift pads can help reduce the risk of workplace injuries for staff, such as pulled muscles, this is not their primary purpose. The main goal of using lift pads is to protect the client from injury during repositioning. Lift pads distribute the client’s weight more evenly, making it easier for staff to move them without straining themselves.

Choice B reason: Lift pads are not designed to absorb urinary incontinence or contain stool. There are specific products like incontinence pads and briefs for managing urinary and fecal incontinence. Lift pads are primarily used to assist with the safe repositioning of immobile clients.

Choice C reason: The primary purpose of lift pads is to help prevent friction and shearing when repositioning the client. Friction and shearing can cause skin damage and pressure ulcers, especially in immobile clients. Lift pads reduce the risk of these injuries by allowing smoother and safer movements.

Choice D reason: Lift pads do not prevent clients from being diaphoretic (sweating excessively). Diaphoresis can be managed through other means, such as adjusting room temperature, using fans, or providing appropriate clothing and bedding. Lift pads are not intended for this purpose.

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Correct Answer is A

Explanation

Choice A Reason:

Metabolic Alkalosis is correct. The pH of 7.56 is above the normal range (7.35-7.45), indicating alkalosis. The HCO3 level of 33 mEq/L is also above the normal range (22-28 mEq/L), which suggests a metabolic cause. In metabolic alkalosis, the body has an excess of bicarbonate or a loss of hydrogen ions.

Choice B Reason:

Metabolic Acidosis is incorrect. Metabolic acidosis is characterized by a low pH (below 7.35) and a low HCO3 level (below 22 mEq/L). The given values indicate alkalosis, not acidosis.

Choice C Reason:

Respiratory Alkalosis is incorrect. Respiratory alkalosis is characterized by a high pH (above 7.45) and a low PaCO2 (below 35 mmHg). In this case, the PaCO2 is elevated (55 mmHg), which does not align with respiratory alkalosis.

Choice D Reason:

Respiratory Acidosis is incorrect. Respiratory acidosis is characterized by a low pH (below 7.35) and a high PaCO2 (above 45 mmHg). While the PaCO2 is elevated, the pH indicates alkalosis, not acidosis.

A. A client who is 3 days postoperative and has a nursing assistant helping him out of bed. B. An adolescent client who has a leg fracture and has been using crutches for the past 2 weeks. C. An older adult client who is confused and has urinary frequency. D. A client with diabetes mellitus who has a leg ulcer.

Correct Answer is C

Explanation

Choice A Reason:

A client who is 3 days postoperative and has a nursing assistant helping him out of bed is at some risk for falls due to recent surgery and potential weakness. However, the presence of a nursing assistant reduces this risk significantly. Postoperative clients are often monitored closely and assisted with mobility to prevent falls.

Choice B Reason:

An adolescent client who has a leg fracture and has been using crutches for the past 2 weeks is at risk for falls due to the use of crutches and limited mobility. However, adolescents generally have better balance and coordination compared to older adults, and they adapt quickly to using mobility aids.

Choice C Reason:

An older adult client who is confused and has urinary frequency is at the greatest risk for falls. Confusion can lead to disorientation and poor judgment, increasing the likelihood of falls. Urinary frequency can cause the client to rush to the bathroom, further increasing fall risk. Older adults also tend to have decreased strength and balance, compounding the risk.

Choice D Reason:

A client with diabetes mellitus who has a leg ulcer is at risk for falls due to potential neuropathy and impaired mobility. However, this risk is generally lower compared to a confused older adult with urinary frequency. The leg ulcer may cause some mobility issues, but it does not typically lead to the same level of disorientation and urgency as urinary frequency.

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A nurse is providing an in-service about repositioning clients and the use of lift pads for immobile clients. What is the rationale for placing lift pads under an immobile client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reviewing the arterial blood gas values for a client. The nurse should recognize that the values indicate which of the following acid-base imbalances? The values are: pH: 7.56 PaCO2: 55 mmHg HCO3: 33 mEq/L Normal ranges: pH: 7.35-7.45 PaCO2: 35-45 mmHg HCO3: 22-28 mEq/L

Correct Answer is A

Explanation

A nurse on the medical-surgical unit is conducting a fall risk assessment on four clients. Which of these clients would be at greatest risk for falls?

Correct Answer is C

Explanation

A nurse is caring for a client who had an arterial blood gas drawn. The pH on the ABG is 7.10. What acid-base imbalance does this client have?

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