A nurse is conducting a mobility assessment on a patient.
The patient can stand up from a seated position using a cane for support.
Which of the following activity levels should the nurse assign to the patient?
Minimal assistance
Moderate assistance
No assistance
Maximum assistance
Maximum assistance
The Correct Answer is C
Choice A rationale
Minimal assistance implies that the patient needs some help but can do most of the task on their own. In this case, the patient is able to stand up from a seated position using a cane for support, which suggests that they do not need assistance.
Choice B rationale
Moderate assistance implies that the patient needs more help to perform the task. The patient in the scenario is able to perform the task independently with the help of a cane.
Choice C rationale
No assistance means that the patient can perform the task independently. This is the most fitting answer because the patient is able to stand up from a seated position using a cane for support.
Choice D rationale
Maximum assistance implies that the patient is unable to perform the task without substantial help. This does not apply to the patient in the scenario as they are able to stand up independently with the help of a cane.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Locking the wheels on the patient’s bed is a safety measure that should be taken to prevent the bed from moving during the transfer.
Choice B rationale
Positioning the chair at a 90-degree angle to the bed could make the transfer more difficult. It’s usually recommended to position the chair parallel to the bed.
Choice C rationale
Elevating the patient’s bed isn’t typically necessary for a transfer and could potentially make the transfer more difficult.
Choice D rationale
Placing the chair on the patient’s left side, the side of the patient’s weakness, could make the transfer more difficult. It’s usually recommended to lead with the patient’s stronger side.
Correct Answer is A
Explanation
Choice A rationale
Post-traumatic stress disorder (PTSD) is a stress-related disorder that can occur after a person experiences a traumatic event. Symptoms can include flashbacks of the traumatic event, which the patient reports experiencing.
Choice B rationale
Episodic acute stress is a type of stress that occurs in response to specific situations or events. It does not typically involve flashbacks of a traumatic event.
Choice C rationale
Irritable bowel syndrome (IBS) is a common disorder that affects the large intestine. While stress can exacerbate symptoms of IBS, it is not a stress-related disorder in the sense of being a psychological response to stress.
Choice D rationale
Acute stress disorder (ASD) is a stress-related disorder that can occur in response to a traumatic event. However, ASD symptoms occur immediately after the traumatic event and typically resolve within a month. Since the patient reports experiencing flashbacks of a traumatic event that occurred a year ago, ASD is not the correct answer.
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