The charge nurse is observing a new nurse administering care during new hire orientation at the hospital. Which activity by the new nurse indicates correct body movement and posture to reduce the risk for injury?

Picks up an item on the far side of the bed by stretching over the mattress.

Bends at the waist to hang a urinary bedside unit on the bed frame.

Pushes the lower drawer of the medication cart closed using one's hip.

Stands erect with knees bent to pull a draw sheet and move the client in bed.

Answer and Explanation

The Correct Answer is D

A.   This can strain the back and increase the risk of injury. It's important to use proper body mechanics, such as bending the knees and keeping the back straight, when reaching for objects.
B.   Bending at the waist can strain the back and increase the risk of injury. It's important to lift objects with the legs, not the back.
C.   This can strain the back and hips. It's important to use proper body mechanics, such as using the legs and core muscles to push or pull heavy objects.
D.   Standing erect with knees bent provides a strong base of support and helps to distribute weight evenly. Bending the knees allows for lifting with the legs, which is less stressful on the back and reduces the risk of injury. Pulling a draw sheet and moving a client in bed requires a combination of strength and proper body mechanics. Standing erect with knees bent helps to prevent strain on the back and muscles

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Correct Answer is B

Explanation

A. While documenting the color and clarity of the urine is important for assessing the client's urinary output and potential issues, it is not the immediate next step in the catheter insertion process. This step typically comes after the catheter is fully inserted and secured.
B. Once urine flow is observed, the next step is to inflate the balloon of the indwelling catheter to secure it in place within the bladder. This ensures the catheter remains correctly positioned and does not move out of the bladder, which is crucial for effective drainage and preventing accidental dislodgement.
C. Asking the client to breathe deeply and exhale does not impact the catheterization process and is not related to the next immediate step after observing urine flow. This action might be helpful in other contexts, such as reducing anxiety or discomfort, but it does not address the technical steps required for catheter insertion.
D. If urine flow is observed in the catheter, it indicates that the catheter is already in the bladder. Inserting the catheter an additional inch is unnecessary and could potentially cause trauma or discomfort. Proper catheter placement is confirmed by the observation of urine flow, and additional insertion is not required.

A. Blood pressure is 142/88 mm Hg. B. 2+ edema of fingers and hands. C. Capillary refill time is 2 seconds. D. Radial pulse volume is 3+.

Correct Answer is B

Explanation

A. Elevated blood pressure can be a concern for overall cardiovascular health but it does not directly affect the accuracy of pulse oximetry readings.
B. Edema, or swelling, of the fingers and hands can affect the accuracy of pulse oximeter readings. Edema can impede proper light transmission through the finger, leading to falsely low oxygen saturation readings.
C. A capillary refill time of 2 seconds is within normal limits, indicating adequate peripheral perfusion. It is unlikely to affect pulse oximeter readings significantly, so this is not a likely cause of a low oxygen saturation reading.
D. A radial pulse volume of 3+ indicates a strong, full pulse. This finding typically suggests good peripheral circulation and is not likely to impact the accuracy of pulse oximetry readings.

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The charge nurse is observing a new nurse administering care during new hire orientation at the hospital. Which activity by the new nurse indicates correct body movement and posture to reduce the risk for injury?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

While inserting an indwelling urinary catheter into a female client, the nurse observes urine flow in the tubing. Which action should be taken next?

Correct Answer is B

Explanation

The nurse attaches a pulse oximeter to a client's finger and obtains an oxygen saturation reading of 91%. Which assessment finding most likely contributes to this reading?

Correct Answer is B

Explanation

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