The client has a deep partial-thickness injury to the posterior neck. Which intervention is most important to use during the acute phase to prevent contractures associated with this injury?
A. Place a towel roll under the client's neck or shoulder.
B. Keep the client in a supine position without the use of pillows.
C. Have the client turn the head from side to side 90 degrees every hour while awake.
D. Keep the client in a semi-Fowler's position and actively raise the arms above the head every hour while awake.
C
The function that would be disrupted by a contracture to the posterior neck is flexion. Moving the head from side to side prevents such a loss of flexion.
You might also like to view...
Which of the following accurately describes a step in this procedure?
A) The medication is injected just below the dermis of the skin. B) Transdermal patches that contain estrogen should be applied to breast tissue. C) When indicated, apply a cold pack to the area to promote absorption. D) The nurse would wear gloves while massaging in the medication.
The nurse is beginning an assessment interview with Joan, an 8-year-old girl who has been brought in for counseling by her parents. One of the nurse's initial questions needs to be:
A) "How are you feeling?" B) "How old are you?" C) "Why do you think your parents brought you here? D) "Why do you think I'm talking to you alone without your parents being here?
A mental health nurse is beginning her assessment of a teenager. What question would be appropriate for the situation?
1. "What types of experiences have caused a major change in your life recently?" 2. "What types of medication do you take?" 3. "Please tell me three things you like about yourself.". 4. All of the above are correct questions to ask in order to assess a teen.
A nurse is preparing to give an antibiotic to a patient who reports being allergic to antibiotics. Before giving the medication, it is important for the nurse to do what?
a. Ask whether the patient has taken this antibiotic for other infections. b. Question the patient about allergies to other medications. c. Obtain a history of other reactions to other drugs. d. Request an order for an antihistamine.