A nurse is providing hygiene care for a client who is immobile. Which of the following actions should the nurse take? (Select all that apply.)

Wash the client's extremities from proximal to distal.

Check for personal items when changing the bed linens.

Shave the client's hair in the direction of the hair growth.

Place a clean gown on the strongest arm first.

Keep the bath water temperature between between 43.3 C (110F) and 46.1 C (115F)

Answer and Explanation

Correct Answer : B,C,E

A.   Washing the client's extremities from proximal to distal is a good practice, but it is not specifically related to caring for an immobile client.
B.   Checking for personal items when changing the bed linens is important to ensure that the client's belongings are not lost or misplaced during the process.
C.   Shaving the client's hair in the direction of hair growth helps prevent skin irritation and ingrown hairs.
D.   The gown should be placed on the weaker arm first.
E.   This is an appropriate temperature that can help client remain comfortable.

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Correct Answer is B

Explanation

A. Using a computer terminal in a non-public area is appropriate and helps maintain client confidentiality.
B. Sharing computer passwords with coworkers is a serious breach of client confidentiality and security. Each individual should have their own unique login credentials to ensure accountability and protect sensitive information.
C. Logging out of the computer before leaving a terminal is a standard practice to protect client information from unauthorized access.
D. Preventing an unidentified healthcare worker from viewing a health record on the computer screen is a responsible action to protect client confidentiality.

A. Checking the pupillary response to light B. Eliciting the gag reflex C. Testing visual acuity D. Observing for facial symmetry

Correct Answer is A

Explanation

A. Cranial nerve III, also known as the oculomotor nerve, controls the muscles that move the eye and regulates the size of the pupil. Assessing the pupillary response to light helps evaluate the function of this nerve.
B. Eliciting the gag reflex is associated with cranial nerves IX (glossopharyngeal) and X (vagus), not cranial nerve III.
C. Testing visual acuity is primarily associated with cranial nerve II (optic nerve), not cranial nerve III.
D. Observing facial symmetry is important for assessing cranial nerve VII (facial nerve), not cranial nerve III.

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A nurse is providing hygiene care for a client who is immobile. Which of the following actions should the nurse take? (Select all that apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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