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.

Answer and Explanation

The Correct Answer is C

A. Reporting any drainage observed around the gastrostomy tube insertion site is important for monitoring potential infection or complications; however, it is not the most immediate concern during a total bed bath.
B. While using plenty of pillows to position the client on the side after bathing is important for comfort and skin integrity, it does not address the safety of the feeding during the bath.
C. Keeping the head of the bed raised while the tube feeding is infusing is the most critical instruction. This position helps prevent aspiration and ensures that the feeding is administered safely while maintaining the client’s airway during the bathing process.
D. Raising the entire bed while bathing the client is helpful for the caregiver's ergonomics but does not take precedence over ensuring the client’s safety regarding the gastrostomy tube feeding.

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Correct Answer is B

Explanation

Choice A: Document the client's loss of memory in the record.

While it's important to document changes in a patient's condition, this should not be the first action. The confusion might be temporary and due to the new environment. It's crucial to first address the patient's immediate needs.

Choice B: Remind the client what day of the week it is.

This is the best action to take. The patient is likely experiencing "relocation stress syndrome," which can cause confusion and disorientation in a new environment. Reminding her of the day can help reorient her and alleviate her confusion.

Choice C: Encourage the client to rest during the day.

While rest is important, it doesn't directly address the patient's confusion about the day of the week. Furthermore, excessive daytime sleep can disrupt the patient's sleep-wake cycle and potentially exacerbate confusion.

Choice D: Notify the family of the change in the client's condition.

While it's important to keep the family informed, this should not be the first action. The nurse should first address the patient's confusion and monitor her to see if the confusion persists or improves.

A. Polyester. B. Silk. C. Rayon. D. Cotton.

Correct Answer is D

Explanation

Cotton is the most suitable fabric for individuals with eczema due to its breathability and hypoallergenic properties.

why the other choices are not the best recommendation:

A.Polyester: Polyester is a synthetic fabric that is not as breathable as natural fibers like cotton. It can trap heat and moisture, potentially exacerbating eczema symptoms and causing discomfort.

B.Silk: While silk is a natural fabric that can feel soft and luxurious, it is not the best choice for individuals with eczema. Silk may cause skin irritation and is not as breathable as cotton.

C.Rayon: Rayon is a semi-synthetic fabric made from cellulose fibers. It can be comfortable and breathable, but it may not be as hypoallergenic as cotton. Some individuals with sensitive skin may still experience irritation when wearing rayon.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

An older female adult who was admitted to a long-term care facility yesterday is confused about what day of the week it is. Her history does not indicate that she was confused prior to admission. What action should the practical nurse (PN) take?

Correct Answer is B

Explanation

The mother of a young child with eczema asks about the type of clothing that is best for her child's comfort. Which choice should the practical nurse (PN) recommend?

Correct Answer is D

Explanation

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