Immediately after log-rolling a client to a lateral position, which intervention should the practical nurse (PN) implement?

Raise the head of the bed 30 degrees.

Measure blood pressure and pulse rate.

Flex legs and place blanket between legs.

Place pillows to maintain alignment.

Answer and Explanation

The Correct Answer is D

Log-rolling is a technique of moving a client as a unit without twisting or bending the spine, which is used for clients with spinal injuries or surgeries. After log-rolling a client to a lateral position, the PN should place pillows to maintain alignment and prevent pressure ulcers or nerve damage. The pillows should be placed under the head, neck, upper arm, chest, abdomen, pelvis, and lower leg.

The other options are not correct because:

A. Raising the head of the bed 30 degrees is not necessary or appropriate after log-rolling a client to a lateral position, as it can cause shearing forces or compromise the spinal stability. The head of the bed should be kept ﬂat or slightly elevated during log rolling.

B. Measuring blood pressure and pulse rate is not the immediate intervention after log-rolling a client to a lateral position, as it does not ensure the comfort or safety of the client. The PN should monitor the vital signs before and after log-rolling, but not during or immediately after.

C. Flexing legs and placing a blanket between legs is not the immediate intervention after log-rolling a client to a lateral position, as it does not support the spine or prevent pressure ulcers or nerve damage. The PN should keep the legs straight and aligned with the body during log-rolling, and place a pillow under the lower leg after log-rolling.

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Correct Answer is C

Explanation

A. Skipped eating lunch would more likely cause hypoglycemia rather than diabetic ketoacidosis (DKA). When a person with type 1 diabetes skips a meal but still takes insulin, blood glucose levels drop, leading to hypoglycemia, not the elevated glucose and ketone production seen in DKA.

B. Incorrectly administered too much insulin would also result in hypoglycemia rather than DKA. Administering excessive insulin causes blood glucose levels to fall too low, which does not trigger the fat breakdown and ketone production that characterize DKA.

C. Had a cold and ear infection for the past two days is the most likely cause of diabetic ketoacidosis. Illness and infection cause the body to release stress hormones such as cortisol and adrenaline, which increase blood glucose levels and counteract insulin. In type 1 diabetes, insufficient insulin leads to hyperglycemia, fat breakdown for energy, and the production of ketones, resulting in DKA.

D. Ate an extra peanut butter sandwich before gym class would not cause DKA. Consuming extra food may raise blood glucose temporarily, but it would not lead to the severe insulin deficiency and ketone production seen in DKA, especially if the adolescent took insulin as prescribed.

A. Elevated energy level. B. Powerful craving for more. C. High self-esteem. D. Euphoria.

Correct Answer is A

Explanation

Rationale for A: Elevated energy level is a common effect of cocaine use, but it does not encompass the full range of behaviors associated with the drug's effects.

Rationale for B: Powerful cravings for more cocaine can develop over time, especially after the initial effects wear off, but they are not the immediate behavior observed.

Rationale for C: High self-esteem may be a temporary effect, but it does not specifically indicate current behavior associated with cocaine use.

Rationale for D: Euphoria is one of the primary effects of cocaine and is typically experienced shortly after use. This intense feeling of pleasure is a hallmark behavior observed in clients who have recently used cocaine.

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Immediately after log-rolling a client to a lateral position, which intervention should the practical nurse (PN) implement?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

An adolescent who was diagnosed with type 1 diabetes mellitus at the age of 9, is admitted to the hospital in diabetic ketoacidosis. Which occurrence is the most likely cause of the ketoacidosis?

Correct Answer is C

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Correct Answer is A

Explanation

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