The practical nurse (PN) is providing instructions to the unlicensed assistive personnel (UAP) preparing to give a total bed bath to an immobile client who has continuous feeding via a gastrostomy tube (GT). Which instruction is most important for the PN to emphasize?
Report any drainage observed around the GT insertion site.
Use plenty of pillows to position the client on the side after bathing.
Keep the head of the bed raised while the tube feeding is infusing.
Raise the entire bed while bathing the client to reduce back strain.
The Correct Answer is C
A. Reporting drainage around the GT site is important for monitoring for infection, but it is not the most critical safety measure during the bath.
B. Using pillows to position the client can provide comfort and support, but it does not prevent a serious complication.
C. Keeping the head of the bed raised during continuous tube feeding is essential to reduce the risk of aspiration, which is a priority safety concern.
D. Raising the bed can reduce back strain for the UAP, but client safety takes precedence over staff ergonomics in this context.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["0.6"]
Explanation
To calculate how many milliliters (mL) the practical nurse (PN) should administer each day, we can first determine the total daily dosage of enoxaparin.
The prescribed dosage is 30 mg every 12 hours, so the total daily dosage is:
30 mg + 30 mg = 60 mg
Next, we can calculate the number of milliliters (mL) needed to deliver the total daily dosage. Since the medication is available in a concentration of 30 mg per 0.3 mL, we can set up a proportion to find the equivalent mL for 60 mg:
30 mg / 0.3 mL = 60 mg / x mL
Cross-multiplying, we get:
30 mg * x mL = 60 mg * 0.3 mL
30x = 18
Dividing both sides by 30, we find:
x = 0.6 mL
Correct Answer is D
Explanation
A: This response is inappropriate as it can be seen as encouraging or validating the patient's comment, which is not professional behavior in a healthcare setting.
B: This choice might seem like a deterrent, but it is more punitive than educational. It does not address the inappropriateness of the comment or guide the patient to understand why the comment was unacceptable.
C: While this statement is true, it does not provide guidance to the patient on appropriate communication. It may also come across as dismissive and does not address the need for respectful interaction.
D: This is the correct response because it sets clear boundaries and communicates to the patient that such comments are not acceptable. It is important for healthcare professionals to maintain a professional environment and educate patients about appropriate behavior.
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