The patient must stay in bed for a bed change. Which actions will the nurse implement? (Select all that apply.)
Turn clean pillowcase inside out over the hand holding it.
Keep soiled linen close to uniform.
Apply sterile gloves.
Make a modified mitered corner with sheet, blanket, and spread.
Advise patient will feel a lump when rolling over.
Correct Answer : A,D
A. Turning the clean pillowcase inside out over the hand holding it helps avoid contamination and allows easy application.
B. Soiled linens should be kept away from the nurse's uniform to prevent cross-contamination; hence, this is incorrect.
C. Sterile gloves are not required for bed-making; clean gloves may be used when handling soiled linens.
D. A modified mitered corner keeps the bed neat and helps secure the sheet, blanket, and spread.
E. Advising the patient of a lump when rolling over is not necessary for bed making, as the goal is to provide comfort without lumps.
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Correct Answer is A
Explanation
A. A moderate-carbohydrate diet is recommended because carbohydrates increase CO₂ production during metabolism, and limiting excessive carbohydrate intake can help manage CO₂ retention in patients with respiratory issues.
B. Low-caffeine is not directly related to CO₂ retention and does not influence carbon dioxide levels in the body.
C. High-carbohydrate intake can exacerbate CO₂ production, worsening retention issues in patients with compromised lung function.
D. High-caffeine intake is not related to CO₂ retention management and would not impact CO₂ levels in the respiratory system.
Correct Answer is A
Explanation
A. Encouraging self-care helps promote independence and functional recovery in stroke patients, supporting rehabilitation and enhancing self-esteem.
B. Bed rest is not recommended as it can contribute to muscle deconditioning and complications associated with immobility.
C. While coordination with therapy is beneficial, gait training is typically handled by physical therapy rather than occupational therapy.
D. Providing a complete bed bath limits the patient’s autonomy; encouraging partial participation supports the patient's involvement in self-care.