Nokea
The nurse is teaching a client who has a hip prostheses following total hip replacement. Which of the following should be included in the instructions for home care?
- A. Avoid climbing stairs for 3 months.
- B. Ambulate using crutches only.
- C. Sleep only on your back.
- D. Do not cross legs.
Correct Answer: D
Rationale: Crossing legs can dislocate the hip prosthesis.
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What is the term used for assessment data that the patient tells you about?
- A. Focused
- B. Objective
- C. Subjective
- D. Comprehensive
Correct Answer: C
Rationale: The correct answer is 'Subjective.' Subjective data includes patient-reported symptoms, feelings, and experiences.
What should the nurse do while dealing with older adults who lose the ability to hear at high-pitched ranges?
- A. Lower the voice pitch.
- B. Insert a stethoscope in the client’s ears.
- C. Use a magic slate or chalkboard.
- D. Ensure that the hearing aid is in good working order.
Correct Answer: A
Rationale: Lowering the voice pitch accommodates age-related hearing loss, improving communication clarity.
At what point should a 24-year-old client without a family history of eye disease have an eye exam?
- A. Annually after the age of 30
- B. Initially, a thorough exam at the age of 40
- C. Initially, a thorough exam at the age of 50
- D. Annually after the age of 50
Correct Answer: B
Rationale: For individuals without risk factors, a baseline eye exam is recommended at age 40 to detect early signs of age-related conditions.
A nursing assistant asks why the client with a chronically low phosphorus level needs so much assistance with activities of daily living. What is your best response?
- A. “The client's low phosphorus is probably due to malnutrition.”
- B. “The client is just worn out from not getting enough rest.”
- C. “The client's skeletal muscles are weak because of the low phosphorus.”
- D. “The client will do more for herself when her phosphorus is normal.”
Correct Answer: C
Rationale: Low phosphorus levels impair energy production in cells, leading to muscle weakness and fatigue, which explains the need for assistance.
In doing a nutritional assessment for Mrs. Collins who wants to lose weight, what should the nurse initially do?
- A. Ask her to describe her actual food intake and behaviors influencing eating
- B. Determine who does the cooking and shopping
- C. Determine what she knows about the basic four food groups
- D. Determine biochemical data such as urinalysis and blood chemistries
Correct Answer: A
Rationale: Understanding the patient's current eating habits and behaviors is crucial for tailoring an effective weight loss plan.