Nokea
During a home visit, the nurse observes an elderly patient trying to walk to the bathroom. The patient appears unstable and clings to furniture while refusing any help. What action should the nurse take?
- A. Suggest that the patient get a walker.
- B. Encourage the patient to acquire a medical alert device.
- C. Ensure the patient's privacy while in the bathroom.
- D. Identify potential safety hazards in the home.
Correct Answer: D
Rationale: Identifying potential safety hazards in the home is the most immediate and effective action the nurse can take. By doing this, the nurse can work with the patient and their family to make necessary changes to improve safety and prevent falls.
You may also like to solve these questions
The Incident Command team discovers that over 30% of essential staff did not receive any communication. What should be done next?
- A. Identify the issue the facility is facing.
- B. Determine two actions the incident team should take to address the issue.
- C. Identify two parameters the team should monitor to ensure all essential personnel are aware of the communication tree.
- D. All of the above.
Correct Answer: D
Rationale: All of the above actions should be taken to address the communication issue. The Incident Command team should identify the issue the facility is facing, determine actions to address the issue, and identify parameters to monitor to ensure all essential personnel are aware of the communication tree.
A 2-month-old infant contracts a disease through vertical transmission. Which situation should the nurse investigate further to ascertain how the infant might have been exposed to the disease?
- A. The infant received a scheduled immunization.
- B. The father fed the infant spoiled baby food.
- C. The mother is breastfeeding the infant.
- D. The infant was bitten by an infected mosquito.
Correct Answer: C
Rationale: Breastfeeding is a common method of vertical transmission. Certain infections in the mother can be passed to the infant through breast milk. Therefore, if a 2-month-old infant contracts a disease that could be transmitted vertically, it would be important to investigate if the mother could be the source of the infection.
A community health nurse who works in a Gulf Coast town that caters to tourists is conducting a disaster management class for residents and business owners. What is the most important content for the nurse to include in this class?
- A. Methods used to treat water to ensure it is safe to drink.
- B. Available evacuation routes from the town.
- C. Hurricane preparedness for families and businesses.
- D. Actions to be taken during a tornado.
Correct Answer: C
Rationale: Given the geographical location of the Gulf Coast town, hurricane preparedness for families and businesses is the most important content to include in the class. Hurricanes are a common natural disaster in this area, and being prepared can help reduce the impact of such events.
During a routine office visit, a nurse is obtaining an older adult client's vital signs and notices the caregiver is very quiet and withdrawn. When asked, the caregiver acknowledges feeling exhausted from caring for the client 24 hours a day. What is the best information for the nurse to provide?
- A. Suggest that social services be contacted to find a respite care facility for the client.
- B. Tell the caregiver to consider hiring a private nurse to provide some time away.
- C. Advise a case management evaluation of the client's home environment.
- D. Recommend that the client's family return to the area to help provide assistance.
Correct Answer: A
Rationale: Respite care is a service that provides temporary relief to primary caregivers, allowing them time to rest and take care of their own needs. It can be provided in the client's home, a healthcare facility, or an adult day care center. This service is especially beneficial for caregivers who are feeling exhausted, as it offers them a break while ensuring that their loved ones continue to receive care.
A patient is admitted to the emergency department with symptoms resembling the flu. What information should the nurse gather to rule out exposure to anthrax spores?
- A. Determine the patient's occupation.
- B. Identify the patient's personal contacts over the past week.
- C. Obtain a twenty-four-hour diet history.
- D. Inquire about previous vaccination for smallpox.
Correct Answer: A
Rationale: Anthrax is a serious disease caused by Bacillus anthracis, a bacterium that forms spores. Certain occupations, such as those involving livestock or animal products, may increase the risk of exposure to anthrax spores.