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)
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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Related Questions
Correct Answer is D
Explanation
A. Standing 1.8 m (6 feet) away from the client is not sufficient for airborne precautions.
Proper respiratory protection is required, such as an N95 mask.
B. Allowing the client to ambulate in the hall is not a specific action related to airborne precautions. If the client needs to leave their room, they should wear a mask to prevent the spread of airborne particles.
C. A positive-pressure airflow room is not typically required for airborne precautions.
However, ensuring proper ventilation in the room is important.
D. Airborne precautions are required for clients with illnesses that spread via small droplets or dust particles that can remain in the air for extended periods. This includes diseases like tuberculosis, chickenpox, and measles. The nurse should wear an N95 respirator mask to provide protection against inhaling these particles.
Correct Answer is A
Explanation
A. This statement is incorrect. While HIPAA allows for certain disclosures to family members, it is important to follow specific guidelines and obtain appropriate consent or authorization from the client when sharing their health information. There are also circumstances where a client may request that information be withheld from certain family members.
B. This statement is correct. HIPAA is a federal law that establishes privacy standards for protected health information.
C. This statement is correct. A client's address is considered personally identifiable information under HIPAA.
D. The statement appears to be cut off. However, it is important to note that HIPAA does indeed establish regulations for protecting individually identifiable health information in various forms, including verbal, electronic, and written.
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