The nurse enters the room as a 3 year-old is having a generalized seizure. Which intervention should the nurse perform first?

Correct Answer: B

Rationale: Side-lying prevents aspiration during a seizure, the immediate priority.

Correct Answer: D

Rationale: Safety is paramount in severe depression due to suicide risk.

Correct Answer: C

Rationale: Respiratory rate is a critical vital sign that reflects how well a patient's body is oxygenating and removing carbon dioxide, key components of basic physiological functioning. It directly indicates the efficiency of the respiratory system, which is essential for life. Pain level, while important for comfort, is subjective and not a direct measure of physiological function. Skin color can provide clues about circulation or oxygenation but is less specific and quantifiable than respiratory rate. Dietary preferences are unrelated to immediate physiological assessment, as they pertain to nutrition rather than real-time bodily function. Nurses monitor respiratory rate to detect distress or deterioration quickly, making it a fundamental metric in patient care. Understanding its significance ensures timely interventions, especially in emergencies where breathing is compromised.

Correct Answer: D

Rationale: Providing privacy and explaining the procedure when using a bedpan upholds the patient's dignity by respecting their autonomy and reducing embarrassment. This involves using curtains, closing doors, and communicating clearly to ensure comfort and consent. Leaving the patient alone risks safety and neglects emotional support, undermining dignity. Using the bedpan without consent violates patient rights and trust. Rushing prioritizes efficiency over sensitivity, potentially causing discomfort or shame. Dignity is a core nursing value explaining the process empowers the patient, while privacy shields them from exposure, aligning with ethical care standards and fostering a respectful environment.

Correct Answer: C

Rationale: Using the legs to lift while keeping the back straight promotes proper body mechanics by distributing weight to the stronger leg muscles, minimizing spinal strain and injury risk. Bending from the waist overloads the back, inviting disc damage. Twisting while lifting compounds this risk, destabilizing the spine. Fully extended arms reduce control and leverage, straining shoulders and back. Nurses apply this technique to protect themselves and patients during transfers, ensuring safety and longevity in physically demanding roles leg power, not back bending, is the key to sustainable lifting.