Which intervention is the most important for the practical nurse (PN) to implement when applying an ice pack to a client?

Wrap the bag in place for comfort.

Secure a protective cover over the bag.

Give directions to leave the pack in place.

Fill the ice pack with crushed ice

Answer and Explanation

The Correct Answer is B

The most important intervention for the practical nurse (PN) to implement when applying an ice pack to a client is to secure a protective cover over the bag. This is essential to protect the client's skin from direct contact with the ice pack, which can cause tissue damage, frostbite, or discomfort.
Securing a protective cover, such as a thin cloth or towel, between the ice pack and the client's skin helps to create a barrier and prevent excessive cold exposure. It allows for the therapeutic benefits of the ice pack, such as reducing swelling and pain, while minimizing the risk of skin damage.
Incorrect:

A. While wrapping the bag in place for comfort is important, it is not the most critical intervention compared to ensuring the protection of the client's skin.
C. Giving directions to leave the pack in place is a general instruction for the client to follow the prescribed treatment, but it does not specifically address the importance of using a protective cover.
D. The type of ice used, whether crushed or cubed, may vary based on availability and preference, but it does not take precedence over the need to protect the client's skin with a cover.

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Correct Answer is A

Explanation

Repositioning the client helps alleviate any discomfort or pressure points that may be interfering with their ability to find a comfortable sleeping position. Providing a back rub can promote relaxation and help the client feel more comfortable.
It is important to address non-pharmacological interventions first before considering medication options. In this case, repositioning and providing a back rub are non-invasive, non-pharmacological interventions that can be effective in promoting sleep.

B. Offering a cup of hot chocolate at bedtime may not address the underlying cause of the client's difficulty in sleeping and may not be the most appropriate intervention at this time.
C. Similarly, administering a prescribed sleep medication should only be considered after non-pharmacological interventions have been attempted and if deemed necessary by the healthcare provider.
D. Administering an as-needed (PRN) prescription for pain may be appropriate if pain is contributing to the client's difficulty in sleeping. However, repositioning and providing a back rub can be the initial interventions to address discomfort and pain before considering additional pain medication.

A. Repeat the heel stick for glucose in one hour. B. Offer nipple feedings of 10% dextrose. C. Begin frequent feedings of breast milk or formula. D. Assess for signs of hypocalcemia.

Correct Answer is C

Explanation

The correct answer is C.

Choice A reason:

Repeating the heel stick for glucose in one hour is not the best first action because it delays necessary treatment and the infant's glucose could drop further, potentially causing harm.

Choice B reason:

Offering nipple feedings of 10% dextrose is not the initial treatment of choice for neonatal hypoglycemia. Oral dextrose gel may be used, but the priority is to provide a source of nutrition, such as breast milk or formula, which offers more sustained glucose levels.

Choice C reason:

Begin frequent feedings of breast milk or formula. This is the first intervention to implement because the infant's current glucose level is below the normal neonatal range of [30 to 60 mg/dL or 1.7 to 3.3 mmol/L], indicating hypoglycemia, which is common in infants of mothers with gestational diabetes. Immediate feeding can help raise the blood glucose level safely.

Choice D reason:

Assessing for signs of hypocalcemia is not the immediate priority. While hypocalcemia can occur in newborns, particularly those with maternal diabetes, the current symptoms and glucose level suggest hypoglycemia is the primary concern. Signs of hypocalcemia include irritability, muscle twitches, jitteriness, tremors, and poor feeding, which can overlap with hypoglycemia symptoms. However, the heel stick glucose level clearly indicates hypoglycemia, which should be addressed first.

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Which intervention is the most important for the practical nurse (PN) to implement when applying an ice pack to a client?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

Correct Answer is C

Explanation

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