The practical nurse (PN) is preparing to transfer an unresponsive client from the bed to a stretcher. Which client data is most important for the PN to obtain before beginning the transfer?
Skin turgor.
Body weight.
Temperature.
Blood pressure.
The Correct Answer is D
A. Skin turgor is important for assessing hydration status, but it is not the most critical factor when preparing for a safe transfer. For an unresponsive client, ensuring stable hemodynamic conditions is more urgent. Blood pressure provides essential information about the client’s circulatory status, which is crucial for assessing the risks associated with the transfer.
B. Body weight is generally used for dosing medications or assessing nutritional status and is not immediately relevant for ensuring a safe transfer of an unresponsive client. Although body weight might be useful in planning the transfer logistics, it does not impact immediate safety concerns.
C. Temperature can indicate infection or other issues but does not directly affect the immediate safety of the transfer process. While monitoring temperature is part of overall care, it is not the most pressing concern during the transfer.
D. Blood pressure is essential to check before the transfer because it reflects the client’s cardiovascular stability. Low or unstable blood pressure might increase the risk of complications during the transfer, such as a sudden drop in blood pressure that could lead to a fall or injury.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B, A, C, D
Explanation
1. Warm the irrigation solution to body temperature to prevent dizziness or discomfort.
2. Position an emesis basin close to the neck under the ear to catch the returning solution and cerumen.
3. Ask the client to tilt the head slightly toward the affected side to allow the solution to flow easily into the ear canal.
4. Pull the pinna of the ear in an upward and backward direction to straighten the ear canal.
5. Direct the flow of the warm solution toward the wall of the ear canal, not directly at the eardrum, to dislodge the impacted cerumen gently.
Correct Answer is B
Explanation
A. Turning on the infant warmer is a necessary step but comes after confirming that the infant is actually being born. The immediate priority is to assess the situation to ensure the health and safety of both the mother and baby.
B. Pushing the call light alerts other healthcare professionals that immediate assistance is needed. Given that the baby is crying, it suggests that the birth may have occurred unexpectedly, and help is required to manage the situation safely.
C. Notifying a healthcare provider is essential, but the PN should first verify the situation to provide accurate information and context for the healthcare provider's arrival.
D. Inspecting the perineum is important to assess for any complications or to check if delivery has occurred. However, this action should follow ensuring that help is called and that the environment is safe for both mother and baby. The primary focus should be on ensuring that assistance is on the way before performing an assessment.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.