A nurse is supervising an assistive personnel (AP. who is caring for a client who is at risk for falls. For which of the following actions by the AP should the nurse intervene?

Assists the client to the bathroom every 2 hr

Locks the wheels on the client's bed

Raises all four side rails on the client's bed

Clears furniture from the path leading to the bathroom

Answer and Explanation

The Correct Answer is C

A. Assisting the client to the bathroom at regular intervals helps prevent falls due to toileting needs.

B. Locking the wheels on the bed prevents unwanted movement and reduces the risk of falls when the client is in bed.

C. Raising all four side rails is considered a restraint, which can increase the risk of falls or injury if the client tries to climb over them. Restraints should be avoided unless absolutely necessary and prescribed by a healthcare provider. In most cases, raising two side rails is sufficient to prevent the client from accidentally rolling out of bed while allowing them to safely exit the bed.

D. Clearing the path from obstacles and furniture reduces the risk of falls by providing a safe and unobstructed route to the bathroom.

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Correct Answer is B

Explanation

A. Weight loss is a potential side effect of methylphenidate, but it is not a direct indicator of medication effectiveness.
B. Correct. Improved ability to complete tasks like homework can be a positive indication of the medication's effectiveness in managing ADHD symptoms.
C. Increased caloric intake might not be directly related to the medication's effectiveness.
D. "A better grasp of reality" is a vague statement and not a specific indicator of ADHD medication effectiveness.

A. Bright red vaginal bleeding B. Persistent uterine contractions C. Increased fetal movement D. Rigid abdomen

Correct Answer is A

Explanation

A. Correct. Placenta previa is a condition where the placenta covers part or all of the cervix.
Bright red vaginal bleeding, especially painless bleeding, is a hallmark sign of placenta previa.
B. Incorrect. Persistent uterine contractions are not a typical finding in placenta previa and could indicate preterm labor or other issues.
C. Incorrect. Increased fetal movement is not a characteristic sign of placenta previa.
D. Incorrect. A rigid abdomen is not associated with placenta previa; it could be a sign of other conditions such as placental abruption.

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A nurse is supervising an assistive personnel (AP. who is caring for a client who is at risk for falls. For which of the following actions by the AP should the nurse intervene?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reinforcing teaching with the parents of a child who has ADHD and is taking methylphenidate. Which of the following statements by the parents indicates that the medication is effective?

Correct Answer is B

Explanation

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Correct Answer is A

Explanation

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