The practical nurses (PN) notes that an unlicensed assistive personnel (UAP) is ambulating a male client who had a stroke and has right-sided weakness. The UAP is walking on the client's left side. Which action should the PN take?
Tell the UAP to take the client back to his room.
Instruct the UAP to walk on the client's affected side.
Take over the ambulation and counsel the UAP later.
Provide client an assistive device, such as a cane or walker.
The Correct Answer is B
A. Tell the UAP to take the client back to his room. - This action might not address the problem and may disrupt the ongoing activity without rectifying the situation.
B. Instruct the UAP to walk on the client's affected side. - When assisting a client with rightsided weakness, the caregiver should support the affected side, providing assistance and stability.
Instructing the UAP to walk on the client's affected side is the appropriate action.
C. Take over the ambulation and counsel the UAP later. - This might disrupt the ongoing care and might not rectify the situation immediately. Addressing it promptly is crucial.
D. Provide the client an assistive device, such as a cane or walker. - While assistive devices can be beneficial, in this scenario, the immediate concern is correcting the UAP's positioning
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Oriented x 3. - The client must recall the time, day, date, location, and reason for being there to be considered oriented x 3. As the client can only remember his name and location, it does not fulfill the criteria for oriented x 3.
B. Oriented x 1. - This is inaccurate as the patient is oriented in two aspects: person and place.
C. Oriented x 2. - The client recalls their name and place, hence is oriented in two aspects. This is therefore accurate.
D. Oriented x 4. - This would require the client to recall all four aspects of orientation (time, day, date, location, and reason for being there), which the client did not demonstrate in this scenario.
Correct Answer is A
Explanation
A. "May I sit with you for a while?" - This response offers companionship and emotional support without pushing the resident to engage in an activity or prying into his feelings. It respects his desire for solitude while providing the option for company if he wishes.
B. "Why do you want to stay in your room today?" - This might be perceived as intrusive and pushy, potentially making the resident more withdrawn.
C. "Come into the recreation area. We have your favorite card game and I will play it with you." - While well-intentioned, this suggestion may not align with the resident's current emotional state or desire for solitude.
D. "I know you are sad about not seeing your family as often, but they are visiting as much as they can." - This response acknowledges the resident's feelings but may not address his immediate need for companionship or support.
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