A nurse is reinforcing teaching with a client about the prevention of stress injuries. Which of the following instructions should the nurse include?

"Keep your knees in a locked position when standing for prolonged periods."

"Bend at the waist when lifting a heavy object."

"Keep your feet close together when lifting a heavy object."

"When lifting a heavy object, keep it close to your body."

Answer and Explanation

The Correct Answer is D

A.   "Keep your knees in a locked position when standing for prolonged periods." This instruction is incorrect. Keeping knees locked can lead to muscle fatigue and increased risk of injury during prolonged standing.
B.   "Bend at the waist when lifting a heavy object." This instruction is incorrect. Bending at the waist during lifting can strain the lower back and increase the risk of back injuries.
C.   "Keep your feet close together when lifting a heavy object." This instruction is incorrect.
Keeping feet close together can make the base unstable and increase the risk of falling or losing balance during lifting.
D.   "When lifting a heavy object, keep it close to your body." Correct. Keeping the heavy object close to the body while lifting helps reduce strain on the back and minimizes the risk of injury. This technique allows the body's core muscles to better support the weight.

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Correct Answer is B

Explanation

A. Keep the conversation moving by asking about the client's family: While engaging the client in conversation is important, this statement does not specifically address the client's difficulty in talking about their illness.
B. Let the client know that as their nurse, they are available and willing to listen: Correct. This response demonstrates the nurse's willingness to provide emotional support and active listening. Encouraging the client to express their feelings and concerns about their illness is essential in promoting therapeutic communication.
C. Ask if the client understands what to expect in the advanced stages of the illness: While discussing the client's understanding of their illness is essential, it does not directly address their difficulty in talking to others about it.
D. Ask the client's visitors not to say anything about the advanced disease: This response may hinder communication and restrict the client's opportunity to talk about their feelings and concerns with supportive visitors.

A. Heart rate 62/min B. Urine output of 200 mL per 8 hr C. Pulse oximetry 95% on room air D. BP 112/76 mm Hg

Correct Answer is B

Explanation

A. Heart rate 62/min: A heart rate of 62 beats per minute is within the normal range for many adults and may not require immediate reporting unless it is a significant change from the client's baseline.
B. Urine output of 200 mL per 8 hr: Correct. A urine output of 200 mL in 8 hours is considered low and may indicate inadequate kidney perfusion or function. It should be reported to the provider as it could be a sign of renal impairment or dehydration.
C. Pulse oximetry 95% on room air: A pulse oximetry reading of 95% on room air is within the normal range for oxygen saturation in most healthy individuals. It does not require immediate reporting unless the client has a specific condition or baseline that warrants concern.
D. BP 112/76 mm Hg: Blood pressure of 112/76 mm Hg is within the normal range for many adults and may not require immediate reporting unless there are specific concerns related to the client's medical history or condition.

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A nurse is reinforcing teaching with a client about the prevention of stress injuries. Which of the following instructions should the nurse include?

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