A nurse is supervising an assistive personnel (AP. who is applying anti-embolic stockings for a client. Which of the following actions by the AP requires intervention by the nurse?
Applying the stockings before the client gets out of bed
Turning the stockings inside out before applying them
Asking the client to point their toes before applying the stockings
Ensuring that creases in the stockings are on the front of the client's legs
The Correct Answer is D
Correct. Applying ant embolic stockings while the client is still in bed helps prevent venous stasis.
Incorrect. Turning the stockings inside out is not a correct step in the application process and should be corrected by the nurse.
Correct. Asking the client to point their toes helps ensure proper positioning of the stockings.
Ensuring that creases are on the front of the legs helps prevent pressure points.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Incorrect. A urine output of 300 ml over 8 hours is within the expected range for a postoperative client and does not require immediate reporting.
B. Incorrect. Occasional small clots in the urine are common in the immediate postoperative period following a transurethral resection of the prostate and do not necessarily require immediate reporting.
C. Correct. Dark red urine can indicate bleeding and may be a sign of hemorrhage. This finding should be reported to the provider for further assessment and intervention.
D. Incorrect. A frequent urge to urinate is expected following a transurethral resection of the prostate, as irritation and swelling can occur in the immediate postoperative period.
Correct Answer is D
Explanation
A. While monitoring oxygen saturation is important, ensuring an open airway takes priority.
B. Administering oxygen is important, but ensuring an open airway is the initial priority.
C. Checking the pulse rate is important, but ensuring an open airway is the initial priority.
D. Correct. Establishing a patent airway is the most critical action for a client with compromised breathing and cyanosis.
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