A home health nurse is assessing the health history of a new client.
Which of the following conditions should the nurse identify as increasing the client’s risk for falls?

Wide-angle glaucoma.

Chronic kidney disease.

Chronic obstructive pulmonary disease.

Osteoarthritis.

Answer and Explanation

The Correct Answer is D

Choice A rationale

Wide-angle glaucoma is a type of eye condition that can affect vision, but it is not typically associated with an increased risk of falls.

Choice B rationale

Chronic kidney disease can have many effects on the body, but it is not typically identified as a direct risk factor for falls.

Choice C rationale

Chronic obstructive pulmonary disease (COPD) can cause shortness of breath and fatigue, which could potentially contribute to instability. However, it is not one of the most common conditions associated with an increased risk of falls.

Choice D rationale

Osteoarthritis can cause pain and stiffness in the joints, which can lead to mobility issues and an increased risk of falls. Therefore, a nurse should identify osteoarthritis as a condition that increases a client’s risk for falls.

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Correct Answer is B

Explanation

Choice A rationale

While it’s important to respect a client’s wishes and provide a supportive environment, avoiding the client’s health status may not be beneficial. Open communication about the client’s condition can help in planning and providing appropriate care.

Choice B rationale

Providing quiet time during visits for prayer or meditation can be a valuable part of a care plan for a client with end-stage breast cancer. This can offer spiritual comfort and peace, which can enhance the client’s quality of life.

Choice C rationale

Placing the client’s name and medical condition on an online prayer chain may not be appropriate without the client’s explicit consent due to privacy concerns.

Choice D rationale

Recommending the client seek out hospice services rather than seek treatment may not be the best approach. The decision between pursuing treatment and entering hospice care should be made by the client and their healthcare team.

A. Client who is ambulatory and exhibits manic behavior B. Client who has a rigid abdomen with manifestations of shock C. Client who has superficial partial thickness burn injuries over 5% of his body D. Client who has a femur fracture with a 2+ pedal pulse

Correct Answer is B

Explanation

Choice A rationale

While manic behavior can be disruptive and may require intervention, it is not typically life- threatening. Therefore, this client would not be the highest priority in a triage situation following a bombing incident.

Choice B rationale

A rigid abdomen with manifestations of shock could indicate serious internal injuries, such as bleeding or organ damage. This client would be a high priority for treatment due to the potential for rapid deterioration and life-threatening complications.

Choice C rationale

Superficial partial thickness burn injuries over 5% of the body, while painful and requiring treatment, are not typically immediately life-threatening. This client would be a lower priority compared to a client with signs of shock and potential internal injuries.

Choice D rationale

A femur fracture with a 2+ pedal pulse indicates that the client has a serious injury, but it is not immediately life-threatening. The presence of a 2+ pedal pulse suggests that circulation to the foot is still intact. This client would be a lower priority compared to a client with signs of shock and potential internal injuries.

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A home health nurse is assessing the health history of a new client.Which of the following conditions should the nurse identify as increasing the client’s risk for falls?

Nursing Test Bank

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A home health nurse is assessing the health history of a new client.
Which of the following conditions should the nurse identify as increasing the client’s risk for falls?