The patient is being assisted to the bathroom for the first time. The recent experience caused a sudden guard and ended up at the hospital. The options for the practical course (PN) are:
Maximize funding and avoid undue pressure on the cesarean incision.
Return the patient to bed and maintain bed rest until the local flow stabilizes.
Adjust fluid consistency and continue to monitor the local flow amount.
Withhold bladder emptying until the Foley catheter is removed and contract the fundus.
The Correct Answer is B
The patient experienced a sudden guard while being assisted to the bathroom, which led to their hospitalization. The most appropriate action for the practical nurse (PN) in this situation is to prioritize the patient's safety and well-being. Returning the patient to bed and maintaining bed rest allows for stability and minimizes the risk of further complications or injury. By providing a safe and controlled environment, the PN can monitor the patient's condition and collaborate with the healthcare team to determine the appropriate course of action moving forward.
Options a), c), and d) are not relevant or appropriate in this context.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Using a cushion when sitting may provide comfort, but it does not directly address the client's elevated blood pressure or changes in mental status related to chronic kidney disease (CKD).
B. Weighing every morning is crucial in managing CKD, particularly with elevated blood pressure, as it helps monitor fluid retention, which can indicate worsening kidney function or fluid overload. This intervention is essential for assessing the client's condition and adjusting treatment as needed.
C. Performing range of motion exercises is important for maintaining mobility, especially in an immobile client; however, it does not directly address the pressing issues of elevated blood pressure and altered mental status.
D. Documenting abdominal girth can be important for assessing fluid retention, but it is less immediate than daily weight monitoring for a client with CKD showing significant symptoms.
Correct Answer is C
Explanation
The best action for the practical nurse (PN) to assist the client in dealing with his pain would be to guide the client through slow, rhythmic breathing.
Guiding the client through slow, rhythmic breathing techniques can help promote relaxation and reduce anxiety, which can indirectly contribute to pain relief. Deep breathing exercises can help the client focus on their breath and divert attention away from the pain, providing some relief and helping them cope with the discomfort. It is a non-pharmacological intervention that can be implemented immediately to help the client manage their pain.
The other options are less effective or not appropriate in this situation:
A. Dimming the lights in the room and closing the door may create a more calming environment, but it does not directly address the client's pain or provide them with effective pain relief.
B. Turning the television on to the client's favorite show may serve as a distraction, but it may not be sufficient to alleviate the client's pain.
D. Obtaining a prescription for a higher dose of pain medication should only be considered after evaluating the client's current pain management regimen and assessing their response to the current medication. It is not the immediate best action to take without further assessment and consideration of other non-pharmacological interventions.
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