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Good Samaritan immunity laws are designed to protect individuals who provide assistance in emergency situations from legal liability, provided they act in good faith and without gross negligence. In this scenario, the nurse did provide initial assistance by turning off the engine and assessing the victim’s condition. However, Good Samaritan immunity typically does not cover situations where the responder leaves the scene before professional help arrives or without ensuring the victim’s safety. Therefore, this choice is not applicable here.

Negligent acts of omission refer to the failure to act when there is a duty to do so, resulting in harm to another person. In this case, while the nurse did leave the scene, the initial actions taken (turning off the engine and assessing the victim) do not constitute a complete failure to act. The nurse did provide some level of care, which complicates the argument for negligence. However, the nurse’s departure before ensuring the victim’s safety could be seen as a partial omission, but it is not the most accurate description of the situation.

Criminal assault and battery involve intentional acts that cause harm or offensive contact to another person. In this scenario, the nurse’s actions were aimed at helping the victim, not causing harm. There was no evidence of intentional harm or offensive contact. Therefore, this choice is not applicable to the situation described.

Donning sterile gloves when caring for clients with HIV is not necessary unless performing a sterile procedure. Standard precautions, including the use of non-sterile gloves, are sufficient for routine care of HIV-positive clients. The focus should be on preventing exposure to blood and body fluids through proper use of personal protective equipment (PPE). This choice reflects a misunderstanding of when sterile gloves are required, as they are not needed for all interactions with HIV-positive clients.

Keeping a pair of gloves in a uniform pocket is not a recommended practice. Gloves stored in pockets can become contaminated, rendering them ineffective when used. Proper storage of gloves in a clean, accessible location is crucial to ensure they remain sterile or clean until needed. This choice indicates a lack of understanding of proper glove storage and the importance of maintaining glove integrity.

Putting on new gloves when entering a client’s room is part of standard precautions, but it does not specifically indicate an understanding of gloving procedures related to handling body fluids. While it is important to use gloves to prevent cross-contamination between patients, this action alone does not demonstrate comprehensive knowledge of when and why different types of gloves are used. This choice shows a basic understanding of infection control but lacks specificity regarding gloving procedures.

Progressing to foot touchdown and weight bearing of the affected leg is not part of the initial three-point gait crutch walking technique. This technique is used when the client cannot bear weight on the injured leg. The client should be using the crutches to support their weight while keeping the injured leg off the ground. This choice indicates a misunderstanding of the three-point gait, which is designed to protect the injured leg from bearing weight.

Practicing bicep and triceps isometric exercises is beneficial for overall strength and can aid in crutch walking, but it does not directly indicate an understanding of the three-point gait technique. These exercises help build the upper body strength needed for crutch use but do not demonstrate the client’s ability to perform the specific gait pattern correctly. This choice reflects a focus on preparation rather than execution.

Inspecting crutches to ensure rubber tips are intact is an important safety measure but does not directly indicate an understanding of the three-point gait technique. While maintaining the crutches in good condition is crucial for safe use, this action alone does not demonstrate the client’s ability to perform the gait correctly. This choice shows attention to safety but does not address the specific requirements of the three-point gait.

Palpating the client’s pedal pulse volume bilaterally is not directly related to the procedure of nasopharyngeal suctioning. While assessing circulation is important, it is not a priority during suctioning. The focus should be on the respiratory status and the effectiveness of the suctioning procedure. This choice indicates a misunderstanding of the primary assessments needed during nasopharyngeal suctioning.

Determining the elasticity of the client’s skin turgor is not relevant to nasopharyngeal suctioning. Skin turgor assessment is typically used to evaluate hydration status, which is not the primary concern during suctioning. The focus should be on respiratory assessments to ensure the client’s airway is clear and they are adequately oxygenated. This choice indicates a misunderstanding of the priorities during nasopharyngeal suctioning.

Auscultating the bowel sounds in all four quadrants is not related to the procedure of nasopharyngeal suctioning. While a comprehensive assessment is important, the priority during suctioning is to monitor the respiratory status and ensure the airway is clear. This choice reflects a lack of focus on the specific assessments needed during the suctioning procedure.

Holding the syringe perpendicular to the skin is not the correct technique for an intradermal injection. The syringe should be held at a 5 to 15-degree angle to ensure the medication is delivered just below the epidermis. This choice indicates a misunderstanding of the proper technique for intradermal injections.

Selecting the upper arm as the injection site is not typical for intradermal injections. Common sites for intradermal injections include the inner forearm and the upper back. This choice indicates a misunderstanding of the appropriate anatomical sites for intradermal injections.

Massaging the site gently after injection is not recommended for intradermal injections. Massaging can disperse the medication and affect the accuracy of the test results, such as in tuberculosis testing. This choice reflects a misunderstanding of the post-injection care for intradermal injections.

Sharing personal values to put the client at ease is not a recommended approach. It can create a bias and make the client feel judged or uncomfortable. The focus should be on the client’s experiences and concerns, not the nurse’s personal values. This choice indicates a misunderstanding of professional boundaries in patient interviews.

Getting the most difficult questions over with first can be overwhelming for the client and may hinder open communication. It is important to build trust and make the client feel comfortable before addressing more sensitive topics. This choice reflects a lack of consideration for the client’s comfort and readiness to discuss sensitive issues.

Asking questions in a vague, non-specific format can lead to misunderstandings and incomplete information. Clear, direct questions are necessary to obtain accurate and relevant information about the client’s sexual activity. This choice indicates a misunderstanding of effective communication techniques in patient interviews.

Positioning the head with the chin tilted slightly downward is a technique known as the chin-tuck maneuver, which helps protect the airway during swallowing. This position reduces the risk of aspiration by closing the airway more effectively. This choice demonstrates an understanding of proper feeding techniques for clients at risk of aspiration.

Placing food on the unaffected side of the mouth is a common practice for clients who have had a CVA and have unilateral weakness. This technique helps ensure that the client can effectively chew and swallow the food, reducing the risk of aspiration. This choice reflects an appropriate feeding strategy for clients with unilateral weakness.

Allowing 30 minutes of rest before feeding is a good practice to ensure that the client is not fatigued and can focus on eating safely. Fatigue can increase the risk of aspiration, so ensuring the client is well-rested before meals is important. This choice demonstrates an understanding of the need to minimize fatigue during feeding.

Switching to a non-rebreather mask is a more aggressive intervention that provides a higher concentration of oxygen. However, before making such a change, it is important to verify that the current setup is functioning correctly. This choice may be appropriate if other measures fail, but it is not the first step.

Increasing the oxygen to 3 L/minute might be necessary if the current oxygen delivery is insufficient. However, before increasing the oxygen flow, it is important to verify that the pulse oximeter is accurately reflecting the client’s oxygen saturation. This choice could be appropriate after confirming the accuracy of the pulse oximeter reading.

Removing the nasal cannula is not an appropriate action as it would decrease the client’s oxygen supply further. This choice indicates a misunderstanding of the appropriate steps to take when addressing low oxygen saturation.

Observing the color and amount of urine is not directly related to the immediate effects of hyperkalemia. While kidney function is important, the primary concern with elevated potassium levels is the effect on cardiac function. This choice indicates a lack of focus on the most critical assessment.

Assessing the strength of deep tendon reflexes can provide information about neuromuscular function, but it is not the most critical assessment for hyperkalemia. The primary concern with elevated potassium levels is the effect on cardiac function. This choice reflects a secondary concern rather than the primary issue.

Comparing muscle strength bilaterally can provide information about neuromuscular function, but it is not the most critical assessment for hyperkalemia. The primary concern with elevated potassium levels is the effect on cardiac function. This choice reflects a secondary concern rather than the primary issue.