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
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Administer a PRN antianxiety agent. - This should be a last resort due to potential side effects.
Non-pharmacological interventions are usually preferable.
B. Tell her no one is behind the curtain. - Arguing or contradicting her belief may escalate her agitation or confusion.
C. Transfer the client to another room. - Moving her to a new environment might exacerbate her confusion and distress.
D. Leave a night light on in her room. - This is a simple, non-intrusive intervention that can help reduce visual misinterpretations and provide comfort, potentially calming her agitation without confrontation or disruption.
Correct Answer is D
Explanation
A. Ask about pain. This is not the most important action because pain is not the primary problem in this situation. Pain may or may not be present, but it does not address the underlying cause of cyanosis.
B. Provide mouth care. This is not the most important action because mouth care does not improve oxygenation. Mouth care may be helpful to prevent infection and promote comfort, but it is not a priority in this case.
C. Offer fluids. This is not the most important action because fluids do not increase oxygen levels in the blood. Fluids may be beneficial to prevent dehydration and maintain circulation, but they are not urgent in this scenario.
D. Administer oxygen. This is the most important action because oxygen is essential for cellular function and survival. Oxygen therapy can reverse hypoxia and improve the client's condition.
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