A nurse is reviewing safety precautions with an assistive personnel (AP) about repositioning a client who has a pressure ulcer. Which of the following actions suggested by the AP indicates an understanding of the procedure?
Use an air-assisted device.
Position the bed in reverse Trendelenburg.
Elevate the head of bed to a 45° angle.
Lower the bed close to the ground.
The Correct Answer is A
A. Use an air-assisted device.
Using an air-assisted device, such as a hover mat or air mattress, is an appropriate measure when repositioning a client with a pressure ulcer. These devices help reduce friction and shear forces, minimizing the risk of further skin breakdown. It also aids in maintaining the skin's integrity during movement, making it a suitable choice for the prevention of pressure ulcers.
B. Position the bed in reverse Trendelenburg:
Positioning the bed in reverse Trendelenburg involves raising the foot of the bed higher than the head. This position is not specifically related to pressure ulcer prevention or repositioning. It may be used for other medical reasons, but it does not directly address the issue of pressure ulcer care.
C. Elevate the head of bed to a 45° angle:
While elevating the head of the bed is commonly used for various reasons, including respiratory support or preventing aspiration, it may not be directly related to the repositioning of a client with a pressure ulcer. The angle mentioned (45°) is not specifically associated with pressure ulcer care.
D. Lower the bed close to the ground:
Lowering the bed close to the ground may be a safety measure to prevent injuries from falls, but it does not address the specific needs of repositioning a client with a pressure ulcer. The focus in pressure ulcer care is typically on using appropriate devices and techniques to minimize friction and pressure on vulnerable areas of the skin.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["0.7"]
Explanation
To calculate the volume (mL) that the nurse should administer, we can follow these steps:
Convert the weight from pounds to kilograms.
1 lb=0.453592 kg.
66 lb×0.453592 kg/lb≈29.937 kg
Calculate the total dose using the weight and prescribed dose:
Total Dose (mg)=Dose per kg×Weight (kg)
Total Dose=0.55 mg/kg×29.937 kg≈16.465 mg
Determine the volume using the concentration of the available solution:
Volume (mL) =Total Dose (mg)/Concentration (mg/mL)
Volume=16.465mg/25 mg/mL≈ 0.6586 mL
Therefore, the nurse should administer approximately 0.7 mL of chlorpromazine for the 0.55 mg/kg IM dose, rounded to the nearest tenth.
Correct Answer is A
Explanation
Fidelity: Fidelity refers to the concept of keeping promises and being faithful to commitments made to individuals. In this scenario, when the nurse states they will return as soon as possible with pain medication, they are making a commitment to the client and demonstrating fidelity by keeping that promise.
Justice: Justice pertains to fairness and the equitable distribution of resources. It is not directly related to the nurse's commitment to providing pain medication.
Autonomy: Autonomy involves respecting the individual's right to make decisions about their own care. While informing the client about the plan for pain medication is part of communication, the primary ethical principle being demonstrated here is fidelity.
Nonmaleficence: Nonmaleficence is the principle of doing no harm. While it is important in healthcare, the scenario described focuses more on the nurse's commitment to providing pain relief.
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