The nurse is assessing the body alignment of an immobilized client. Which is the best client position for the nurse to obtain an accurate assessment?

Prone.

Sims.

Supine.

Fowlers.

Answer and Explanation

The Correct Answer is C

A. Prone: Prone positioning limits assessment of spinal curvature, extremity alignment, and body symmetry because the client is lying on the abdomen, which can obscure certain postural deviations.

B. Sims: Sims position is primarily used for rectal or vaginal procedures and does not provide a full view of overall body alignment, making it less ideal for assessment purposes.

C. Supine: Supine position allows the client to lie flat on the back with the body fully supported. This position provides the best view of the head, neck, spine, shoulders, hips, and extremities for a comprehensive assessment of body alignment.

D. Fowlers: Fowlers position elevates the head and torso, which may alter natural spinal alignment and obscure an accurate assessment of posture and symmetry compared with a flat, supine position.

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Correct Answer is {"A":{"answers":"B"},"B":{"answers":"B"},"C":{"answers":"A,B"},"D":{"answers":"B"},"E":{"answers":"A"}}

Explanation

• Refrain from sharing towels and razors with others: Prevents transmission of bacteria that can enter through minor skin breaks and cause cellulitis. Maintaining personal hygiene items reduces the risk of reinfection or spreading pathogens to others.

• Complete full course of antibiotic therapy: Promotes healing by ensuring that the bacterial infection is fully eradicated. Stopping antibiotics prematurely can lead to treatment failure, recurrence, or development of resistant organisms.

• Wash hands before and after touching open wounds including bug bites: Prevents future cellulitis by reducing the likelihood of introducing bacteria to compromised skin. Proper hand hygiene is a key preventive measure for both the client and caregivers.

• Shower daily with antibacterial soap: Helps prevent future cellulitis by reducing bacterial load on the skin. Regular cleansing is particularly important in clients with diabetes or peripheral vascular disease, who are more prone to skin infections.

• Eat foods which contain protein and vitamin C: Promotes healing by supporting tissue repair and immune function. Adequate nutrition enhances wound healing, reduces recovery time, and strengthens defenses against infection.

A. Provide a bedside commode for toileting. B. Assist with ambulation in the hallway. C. Teach to sleep in a side-lying position. D. Encourage active range of motion exercises.

Correct Answer is A

Explanation

A. Provide a bedside commode for toileting: Minimizing physical exertion helps reduce cardiac workload in a client with heart failure. Providing a bedside commode decreases the need for frequent trips to the bathroom, conserving energy and reducing strain on the heart.

B. Assist with ambulation in the hallway: While ambulation promotes circulation and prevents complications of immobility, it increases oxygen demand and cardiac workload, which may not be safe for a client with acute heart failure.

C. Teach to sleep in a side-lying position: Side-lying may improve comfort but does not significantly impact cardiac workload or oxygen consumption compared with upright or semi-Fowler positions that promote easier breathing.

D. Encourage active range of motion exercises: Active exercises increase metabolic demand and cardiac workload. Although beneficial long-term, they should be limited during acute illness to prevent overexertion and exacerbation of heart failure.

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The nurse is assessing the body alignment of an immobilized client. Which is the best client position for the nurse to obtain an accurate assessment?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Patient Data Exhibits Click to indicate which education instructions the nurse should include to prevent future cellulitis and promote healing when preparing the client for discharge. Each column must have at least one response selected.

Correct Answer is {"A":{"answers":"B"},"B":{"answers":"B"},"C":{"answers":"A,B"},"D":{"answers":"B"},"E":{"answers":"A"}}

Explanation

A client with heart failure is admitted to the medical surgical unit with pneumonia. To reduce cardiac workload, which intervention should the nurse include in the plan of care?

Correct Answer is A

Explanation

Patient Data Exhibits Drag from Word Choices to complete the sentence. According to the laboratory values, the client has dropdown ; related to dropdown , or dropdown.

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