Nokea
A client with a hip fracture is using a walker. Which observation indicates incorrect use of the walker?
- A. The client leans forward over the walker.
- B. The client advances the walker before stepping.
- C. The client uses the walker on both sides.
- D. The client keeps elbows slightly bent.
Correct Answer: A
Rationale: Leaning forward over the walker compromises balance and increases fall risk.
You may also like to solve these questions
The nurse observes that a client's ileostomy output is green and watery. Which action should the nurse take first?
- A. Notify the physician immediately.
- B. Document the finding as normal.
- C. Increase the client's fiber intake.
- D. Administer an antidiarrheal medication.
Correct Answer: B
Rationale: Green, watery output is normal for an ileostomy, especially early post-surgery, and should be documented. Notifying the physician, increasing fiber, or giving antidiarrheals are unnecessary unless other symptoms arise. CN: Physiological adaptation; CL: Synthesize
When developing a discharge plan to manage the care of a client with chronic obstructive pulmonary disease (COPD), the nurse should advise the client to expect to:
- A. Develop respiratory infections easily.
- B. Maintain current status.
- C. Require less supplemental oxygen.
- D. Show permanent improvement.
Correct Answer: A
Rationale: COPD clients are prone to respiratory infections due to impaired lung defenses. Maintaining status is possible but not an expectation. Oxygen needs may increase, and COPD is progressive, not permanently improved.
The risk for injury during an attack of Ménière'sdisease is high. The nurse should instruct the client to take which immediate action when experiencing vertigo?
- A. Place your head between your knees.
- B. Concentrate on rhythmic deep breathing.
- C. Close your eyes tightly.
- D. Assume a reclining or flat position.
Correct Answer: D
Rationale: Assuming a reclining or flat position during a vertigo attack minimizes the risk of falling and injury by stabilizing the client's position.
A client post-extracorporeal shock wave lithotripsy should report:
- A. Mild hematuria.
- B. Severe flank pain.
- C. Clear urine.
- D. Bruising.
Correct Answer: B
Rationale: Severe flank pain may indicate a complication like hematoma or obstruction.
An advantage of using biologic burn grafts such as porcine (pigskin) grafts is that they appear to help:
- A. Encourage formation of tough skin.
- B. Promote the growth of epithelial tissue.
- C. Provide for permanent wound closure.
- D. Facilitate development of subcutaneous tissue.
Correct Answer: B
Rationale: Porcine grafts act as a temporary biological dressing, promoting epithelial tissue growth by providing a protective barrier and stimulating healing. They do not form tough skin, provide permanent closure, or directly affect subcutaneous tissue.