A nurse is setting up the equipment to assist with a sigmoidoscopy while the practical nurse (PN) positions the client in a flat prone position. Which action should the nurse implement?
Assume care of the client and assign the PN to the care of a different client.
Arrange for unlicensed assistive personnel to assist the PN during the procedure.
Acknowledge that the PN has positioned the client safely and correctly.
Demonstrate to the PN how to position the client more effectively for the procedure.
The Correct Answer is D
Choice A reason: Assuming care of the client and reassigning the PN does not address the immediate need to correct the client's position for the sigmoidoscopy.
Choice B reason: While assistance may be needed, it is more important to first ensure that the client is in the correct position for the procedure.
Choice C reason: Acknowledging the PN's action would be incorrect since the client has not been positioned safely and correctly for a sigmoidoscopy.
Choice D reason: Demonstrating the correct positioning ensures the procedure can be performed effectively and safely, which is the nurse's immediate responsibility.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Right lower abdominal pain is not typically associated with Wernicke's syndrome and would likely indicate a different issue.
Choice B reason: Peripheral neuropathy can be a symptom of Wernicke's syndrome, but it is not as central to the condition as confusion, which is a hallmark sign.
Choice C reason: Confusion is a primary symptom of Wernicke's syndrome and should be used in planning the client's care, as it indicates acute encephalopathy and the need for immediate treatment with thiamine.
Choice D reason: Depression may be present in clients with Wernicke's syndrome, but it is not a primary assessment finding used to plan care for the acute stage of the condition.
Correct Answer is A
Explanation
Choice A reason: Engaging in non-threatening conversations can help the client feel more comfortable and may encourage communication, which is crucial for clients who are withdrawn due to depression.
Choice B reason: Family visits can be supportive, but the client's withdrawal suggests a need for more direct intervention to encourage communication.
Choice C reason: Scheduling a conference with a social worker is important, but it is not the most immediate intervention for a withdrawn client.
Choice D reason: Group activities may be overwhelming for a client who is noncommunicative and may not be the most suitable initial approach.

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