A female client with degenerative disc disease and chronic sciatica is describing numbness and tingling down her left leg. Which assessment should the nurse obtain first?

Duration of sensation.

Precipitous activiity.

Time of last analgesic.

Gait coordination.

Answer and Explanation

The Correct Answer is A

Rationale:
A. Duration of sensation: This helps to determine if the symptoms are acute, intermittent, or continuous, which can provide clues about the severity of nerve compression or irritation. Changes in duration, frequency, or intensity can indicate worsening nerve impingement or the development of a new neurological deficit requiring immediate attention.

B. Precipitous activity: While it's useful to know what activity triggered the symptoms, this is secondary to understanding the timeline and progression of neurological signs, which carry more urgency.

C. Time of last analgesic: Pain control is important, but the priority is evaluating potential nerve compromise. Numbness and tingling may reflect compression or damage that cannot be addressed by analgesia alone.

D. Gait coordination: Assessing gait coordination is important to evaluate the functional impact of the neurological symptoms, which could indicate more severe nerve compression affecting motor pathways. However, it is an assessment of a motor function. The client is describing sensory symptoms.

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Correct Answer is ["B","C","D"]

Explanation

Rationale:
A. Consider having the teen's caregiver wait in the clinic reception area: Adolescents with ASD may experience heightened anxiety in unfamiliar environments. Having their caregiver nearby can offer a sense of security and comfort, making the experience less overwhelming.

B. Encourage the adolescent to handle the physical exam instruments: Allowing the adolescent to touch and explore the equipment before use helps reduce sensory-related anxiety. It also increases cooperation by promoting a sense of predictability and control.

C. Allow time for talking before beginning the physical assessment: Taking time to communicate and build rapport before initiating the assessment helps reduce anxiety and fosters trust. Many adolescents with ASD need more time to process information and adjust to new interactions.

D. Familiarize the adolescent with the clinic setting and healthcare staff: Gradual exposure to the physical space and people helps reduce sensory overload and builds comfort with the environment. Structured familiarity can prevent overstimulation and improve cooperation.

E. Make every effort to establish eye contact with the adolescent: Insisting on eye contact can increase distress, as many individuals with ASD find direct eye contact uncomfortable or overwhelming. Respecting their communication style is more effective than imposing neurotypical expectations.

A. Balance and posture. B. Risk for disuse syndrome. C. Pressure sore risk. D. Upper body muscle strength.

Correct Answer is D

Explanation

Rationale:
A. Balance and posture: Although relevant for general mobility, a trapeze bar is primarily used while in bed, where balance and posture are less critical than the strength to use the device effectively.

B. Risk for disuse syndrome: This risk supports the need for mobility aids like a trapeze, but it does not determine whether the client can use the device safely and independently.

C. Pressure sore risk: This is important for overall care planning, but not the most relevant assessment for determining safe and effective trapeze use.

D. Upper body muscle strength: Adequate arm and shoulder strength are essential for the client to grasp and lift themselves using the trapeze bar. Without this, using the bar could lead to falls or injuries.

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A female client with degenerative disc disease and chronic sciatica is describing numbness and tingling down her left leg. Which assessment should the nurse obtain first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

An adolescent with autism spectrum disorder (ASD) comes to the clinic for the first time. Which intervention(s) should the nurse implement? Select all that apply.

Correct Answer is ["B","C","D"]

Explanation

Prior to obtaining a trapeze bar for a client with limited mobility, which client assessment is most important for the nurse to obtain?

Correct Answer is D

Explanation

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