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Difficulty: HardBasic Care and Comfort

A practical nurse (PN) is preparing to transfer a client from the bed to a bedside chair for the first time following abdominal surgery. To ensure client safety and comfort, in what order should the PN perform the following actions? (Arrange the steps in the correct chronological sequence.)

  1. 1Raise the head of the bed to a high-Fowler's position.
  2. 2Assist the client to pivot and sit on the edge of the bed.
  3. 3Allow the client to dangle their legs while assessing for dizziness.
  4. 4Apply a transfer belt securely around the client's waist.
  5. 5Assist the client to stand, pivot, and sit in the bedside chair.

Answer

The nurse must first raise the head of the bed, assist the client to sit on the edge, allow them to dangle while assessing for dizziness, apply a transfer belt, and finally assist them to stand and pivot into the chair.
Safe mobility for a post-operative client requires a deliberate, step-by-step approach to prevent orthostatic hypotension and protect the surgical site. The head of the bed is elevated first to initiate cardiovascular adjustment and ease movement. After pivoting to the edge of the bed, the client must dangle to ensure they are not experiencing dizziness. Only after stability is confirmed is a transfer belt applied to provide physical support. Finally, the nurse assists the client to stand and pivot into the chair.

Step-by-Step Solution

1
Raise the head of the bed to a high-Fowler's position.
The client is transitioned from a supine to an upright seated position in bed.
This gradually introduces orthostatic changes and minimizes physical strain on the abdominal surgical site when moving.
2
Assist the client to pivot and sit on the edge of the bed.
The client is positioned at the edge of the mattress with their feet toward the floor.
This is a prerequisite physical maneuver before weight-bearing and standing.
3
Allow the client to dangle their legs while assessing for dizziness.
The client rests in a seated position while the nurse evaluates their physiological tolerance.
Post-operative clients are at high risk for orthostatic hypotension. Dangling prevents syncope and potential falls.
4
Apply a transfer belt securely around the client's waist.
The nurse establishes a safe, mechanical gripping point on the client.
Applying the belt while the client is sitting ensures it is snug and ready for the standing transfer without compromising the client's balance.
5
Assist the client to stand, pivot, and sit in the bedside chair.
The client is safely relocated from the bed to the chair.
This finalizes the transfer using safe body mechanics and physical support.

Key Concept

Safe Post-Operative Client Transfer and Positioning
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Topics

Basic Care and Comfort

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