An elderly client admitted for heart failure and experiencing lower back pain is seen attempting to get out of bed to go to the bathroom. The client's activity status includes bathroom privileges
Which of the following should the nurse do to support this client? 1. Provide the client with a bed pan
3. Assess the client's ambulation status and provide assistive aids as appropriate
4. Ask the physician for an order for restraints
5. Instruct the client to stay in bed according to the physician's orders
2. Assess the client's ambulation status and provide assistive aids as appropriate
Rationale:
The client has a chronic health problem and lower back pain. The client also is permitted bathroom privileges. The best intervention for the nurse to do to support the client would be to assess the client's ability to ambulate and provide assistive aids as appropriate. Providing a bed pan does not support the activity status. Asking the physician for an order for restraints is inappropriate. Instructing the client to stay in bed according to the physician's orders is also incorrect since the client's activity status is bathroom privileges.
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