A nurse is caring for an 84-year-old female client in her home following an investigation by Adult Protective Services.

Exhibits

Drag from the statement options to complete the sentence.
To assess outcomes, the nurse should consider information reported by the client and caregiver and focus on evaluating the client’s:

Psychological assessment

Financial security

Quality of life

Functional improvement

Answer and Explanation

The Correct Answer is D

Choice A rationale: While psychological assessment is important, it is not the primary focus for assessing outcomes in this case. The client's physical health conditions and the impact on her daily living and functional ability are more directly relevant.

Choice B rationale: Financial security is not the primary concern in this context. The primary focus is on the client's health and ability to perform activities of daily living (ADLs), which is addressed by evaluating functional improvement.

Choice C rationale: Quality of life is a broad concept that includes many aspects such as emotional, social, and physical well-being. While it is relevant, the primary outcome measure in this context is the client's functional improvement related to her health conditions and ability to manage ADLs.

Choice D rationale: Functional improvement is the correct focus for evaluating the client's outcomes. This includes her ability to perform activities of daily living (ADLs) and manage her health conditions. The nurse should assess how well the client can maintain or improve her functional abilities with the additional care provided.

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

Explanation

Choice A rationale

Calcium carbonate is a common medication used to manage low calcium levels, but in clients with hyperparathyroidism, it can exacerbate hypercalcemia, leading to dangerous levels of calcium in the blood. Hyperparathyroidism already causes increased calcium release from bones, increased absorption from the intestines, and decreased excretion by the kidneys, so adding calcium carbonate can worsen these effects, potentially leading to complications like kidney stones, bone pain, and cardiovascular issues. Careful monitoring and possible dose adjustments or discontinuation might be necessary.

Choice B rationale

Acetaminophen is an analgesic and antipyretic commonly used for pain relief and fever reduction. It is metabolized primarily in the liver and does not significantly impact calcium levels or parathyroid hormone function. Therefore, it does not pose an immediate concern for clients with hyperparathyroidism and can typically be used safely without requiring further discussion with the healthcare provider unless there are other contraindications or hepatic issues in the client's medical history.

Choice C rationale

Hydrochlorothiazide is a thiazide diuretic often used to manage hypertension and edema. It reduces urine calcium excretion, which can lead to increased serum calcium levels, exacerbating hypercalcemia in clients with hyperparathyroidism. Thiazide diuretics promote calcium reabsorption in the distal convoluted tubules of the kidneys, potentially worsening the hypercalcemia caused by hyperparathyroidism. Therefore, the use of hydrochlorothiazide should be carefully evaluated and potentially avoided in these clients.

Choice D rationale

Lithium carbonate is used to treat bipolar disorder and can affect parathyroid function, leading to increased parathyroid hormone (PTH) levels and hypercalcemia. Lithium can alter the set point of the calcium-PTH feedback loop, leading to increased release of PTH, even at normal calcium levels. This can result in worsening hyperparathyroidism and hypercalcemia, making it a medication that requires careful consideration and monitoring in affected clients.

Choice E rationale

A. Offer to assist the client to void prior to walking in the hall. B. Instruct the client about signs of orthostatic hypotension. C. Measure the client's vital signs before the client walks. D. Report the onset of any dizziness or light-headedness. E. Determine if the client needs to have a gait belt applied.

Correct Answer is ["A","C","D","E"]

Explanation

Choice A rationale

Assisting the client to void before walking can prevent potential incontinence episodes, which might be embarrassing for the client. Additionally, a full bladder can increase the risk of falls due to discomfort or urgency to get to the restroom quickly.

Choice B rationale

While instructing the client about signs of orthostatic hypotension is important, it is not within the scope of practice for an unlicensed assistive personnel (UAP) to provide such instructions. This task falls under the responsibility of a licensed nurse.

Choice C rationale

Measuring the client's vital signs before walking helps to assess the client's baseline status and ensures that the client is stable enough to engage in physical activity. Any abnormal readings could indicate the need to postpone or modify the activity.

Choice D rationale

Reporting the onset of any dizziness or light-headedness is crucial for ensuring the client's safety during activity. These symptoms could indicate underlying issues such as orthostatic hypotension or other cardiovascular problems that need to be addressed promptly.

Choice E rationale

Determining if a gait belt is needed ensures that the client receives appropriate support while walking. A gait belt can provide additional stability and help prevent falls, especially for clients with limited tolerance for activity.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is managing the care for a client with hyperparathyroidism and is reviewing the client's list of prescribed and over-the-counter medications. Which medication(s) on the client's current medication record should the nurse discuss further with the healthcare provider? Select all that apply.

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

Explanation

A client with limited tolerance for activity needs to walk in the hallway with assistance. Which instruction(s) should the nurse give to the unlicensed assistive personnel (UAP) who is assisting with the client's care? Select all that apply.

Correct Answer is ["A","C","D","E"]

Explanation

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