A client is discharged to home following hospitalization for percutaneous endoscopic gastrostomy tube placement to assist with nutrition. The client's primary diagnosis is amyotrophic lateral sclerosis (ALS). The client can transfer from the bed to a chair but can't walk.
The client and their family are concerned about the client's ability to maintain mobility at the highest possible level following a surgical procedure. The nursing diagnosis most appropriate for this client is ...
Impaired physical mobility related to decreased motor agility secondary to ALS as manifested by inability to ambulate.
Hopelessness related to impaired ability to cope.
Caregiver role strain related to care recipient's unrealistic expectations of caregiver.
Impaired memory related to reduced quality and quantity of information processed.
The Correct Answer is A
Choice A rationale: In ALS, impaired physical mobility due to decreased motor agility and the inability to ambulate is a direct consequence of the disease.
Choice B rationale: Hopelessness might be a possible emotional response but doesn't address the client's physical limitations due to ALS.
Choice C rationale: Caregiver role strain is related to the family's ability to manage caregiving responsibilities and is not the primary concern for the client's physical mobility.
Choice D rationale: Impaired memory is not the primary issue in ALS; the client's inability to ambulate due to decreased motor function is the main focus for this nursing diagnosis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","D","F"]
Explanation
Choice A rationale: Altered consciousness is a hallmark feature of delirium, where individuals may experience fluctuations in awareness.
Choice B rationale: Delirium typically has an acute onset rather than symptoms developing over months to years.
Choice C rationale: Delirium often has a fluctuating course, rather than a consistent progressive decline.
Choice D rationale: Delirium can result from various factors including fluid/electrolyte imbalances or infections.
Choice E rationale: While these conditions might contribute to cognitive impairments, they are not typically associated with delirium.
Choice F rationale: Delirium can affect judgment, but it's not a defining feature.
Choice G rationale: While memory impairments can be seen in delirium, they're often accompanied by altered consciousness and fluctuations in awareness.
Correct Answer is A
Explanation
Choice A rationale: The frontal lobe, specifically Broca's area located in the dominant hemisphere, is responsible for expressive speech. Damage to this area can result in expressive aphasia or difficulty expressing speech.
Choice B rationale: The occipital lobe primarily processes visual information.
Choice C rationale: The temporal lobe is involved in auditory processing and language comprehension.
Choice D rationale: The parietal lobe is involved in spatial perception, attention, and sensory information processing.
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