Difficulty: Medium
Average Score: 73%
Simulated
The nurse observes an unlicensed assistive personnel (UAP) who is providing a total bed bath for a confused and lethargic client. The UAP is soaking the client├óÔé¼Ôäós foot in a basin of warm water placed on the bed. Which action should the nurse take?
Correct answer
A
Rationale
Placing a basin of water on the bed is a safety hazard. A confused and lethargic client could spill the water, leading to falls, skin breakdown, or increased infection risk if the wound is present. The immediate action is to remove the hazard. Educating the UAP on proper technique (drying between toes) is important but secondary to ensuring immediate safety. Adding cream to the water is not standard practice.