a nurse is reviewing measures to prevent back injuries with assistive personnel ap which of the following instructions should the nurse include
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HESI LPN

HESI Fundamentals Test Bank

1. A healthcare professional is reviewing measures to prevent back injuries with assistive personnel (AP). Which of the following instructions should the healthcare professional include?

Correct answer: A

Rationale: The correct instruction to prevent back injuries while lifting is to spread your feet apart to provide a wide base of support. This helps in maintaining stability and reduces the risk of back injury. Choice B is incorrect as lifting objects with your back straight and using your legs is the recommended technique. Choice C is incorrect because assistive devices can actually help prevent back injuries by providing support. Choice D is incorrect as bending at the waist to reach objects can strain the back muscles and increase the risk of injury.

2. While bathing a patient, the nurse notices movement in the patient's hair. What action should the nurse take?

Correct answer: A

Rationale: When a nurse suspects pediculosis capitis (head lice) upon noticing movement in the patient's hair, the correct action is to use gloves to inspect the hair. This protects the nurse from potential self-infestations. Applying a lindane-based shampoo immediately (Choice B) is not the first action, as diagnosis and confirmation are necessary before treatment. Shaving the patient's hair off (Choice C) is an extreme measure and is unnecessary at this stage. Ignoring the movement and continuing (Choice D) is negligent and can lead to the spread of infestation.

3. The nurse is caring for an older adult patient diagnosed with Alzheimer's disease who is ambulatory but requires total assistance with activities of daily living (ADLs). The nurse notices that the patient is edentulous. Which area should the nurse assess?

Correct answer: A

Rationale: The correct answer is to assess the oral cavity. 'Edentulous' means without teeth, so the nurse should assess the oral cavity for any issues related to oral health, dentures, or potential complications. This assessment is crucial to prevent oral health problems and ensure proper care for the patient. Assessing the room for drafts (choice B) is unrelated to the patient's edentulous status and does not address the immediate care needs. Assessing ankles for edema (choice C) is important for circulatory assessment but not directly related to the patient being edentulous. Assessing for reduced sensations (choice D) would be more relevant for neurological or sensory concerns, which are not specifically associated with being edentulous.

4. A nurse on a medical unit is preparing to discharge a client to home. Which of the following actions should the nurse take as part of the medication reconciliation process?

Correct answer: A

Rationale: The correct answer is A: Compare prescriptions with medications the client received during hospitalization. This step is crucial in ensuring the accuracy of medication reconciliation. By comparing the current prescriptions with the medications administered during the hospital stay, the nurse can identify any discrepancies, omissions, or duplications in the medications. This comprehensive comparison helps prevent medication errors and ensures that the client's home medications align with the treatment received in the hospital. Choice B is incorrect because solely reviewing the client's current medications may overlook important changes or additions made during the hospitalization. Choice C is incorrect as providing a list of medications without checking for interactions can lead to potential adverse effects or drug interactions. Choice D is incorrect as discussing the client's medication history without verification may not provide an accurate representation of the medications the client actually received during the hospital stay.

5. When working with a client who does not speak the same language as the nurse and an interpreter is present, which of the following actions should the nurse take?

Correct answer: A

Rationale: When caring for a client who speaks a different language, it is essential to communicate through an interpreter. Talking directly to the client, rather than the interpreter, ensures clear and respectful interaction. Speaking loudly to the interpreter (choice B) is not necessary and may be perceived as disrespectful. Using gestures (choice C) alone may lead to misunderstandings or misinterpretations. Avoiding the use of an interpreter and relying solely on family members (choice D) can compromise the accuracy and confidentiality of the communication.

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