A nurse is reviewing a fall risk assessment for a client.
Which of the following findings place the client at risk for a fall? Select all that apply.

Electrical cord on floor over walkway.

Uses a cane to ambulate.

Unsecured throw rugs over tile floor in kitchen.

Macular degeneration.

Answer and Explanation

Correct Answer : A,C,D

Choice A rationale
An electrical cord on the floor over a walkway can pose a tripping hazard, increasing the risk of falls. It’s important to keep walkways clear of any obstacles to prevent falls.
Choice B rationale
Using a cane to ambulate does not necessarily increase the risk of falls. In fact, canes are often used to improve balance and stability, reducing the risk of falls. However, it’s important that the cane is used correctly and is the right height for the individual.
Choice C rationale
Unsecured throw rugs, especially over a slippery surface like a tile floor, can easily cause someone to slip and fall. It’s recommended to secure rugs with non-slip backing or remove them entirely from high-traffic areas.
Choice D rationale
Macular degeneration can lead to vision loss, which can increase the risk of falls. Individuals with vision impairments may not be able to see hazards in their path, making them more prone to falls.

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Correct Answer is B

Explanation

Choice A rationale
This statement is not accurate. Relapsing-remitting multiple sclerosis (RRMS) is characterized by periods of new symptoms or relapses that develop over days or weeks and usually improve partially or completely. These episodes are followed by periods of remission, where the disease does not progress. Therefore, RRMS does not cause a steady and gradual decline in function.
Choice B rationale
This is the correct answer. Stress and extreme fatigue can trigger a relapse in RRMS1. Therefore, it is important for patients to avoid these triggers to manage their symptoms effectively.
Choice C rationale
This statement is incorrect. RRMS is the most common disease course at the time of diagnosis. It is not the least common type of multiple sclerosis.
Choice D rationale
This statement is not accurate. Medications for RRMS, known as disease-modifying treatments (DMT), are designed to reduce the frequency and severity of relapses. They are not intended to be taken only during times of relapse, but rather on an ongoing basis to manage the disease.

A. “This treatment should help me live a little longer and give me hope for a cure.”. B. “I will continue my strict dietary plan.”. C. “I am hoping this will limit my discomfort and give me the best quality of life for me.”. D. “This is not working and I plan to stop treatment.”.

Correct Answer is C

Explanation

Choice A rationale
While palliative care can indeed help improve a patient’s quality of life, it is not typically aimed at curing the disease or significantly prolonging life. Instead, the focus is on managing symptoms and improving comfort. Therefore, the statement “This treatment should help me live a little longer and give me hope for a cure” does not accurately reflect the goals of palliative care.
Choice B rationale
The statement “I will continue my strict dietary plan” does not necessarily indicate an understanding of palliative care. While maintaining good nutrition can be an important part of managing some conditions, palliative care is more focused on symptom management and improving quality of life. Strict dietary restrictions may not be necessary or beneficial in a palliative care context.
Choice C rationale
The statement “I am hoping this will limit my discomfort and give me the best quality of life for me” accurately reflects the goals of palliative care. Palliative care aims to manage symptoms, including pain and discomfort, and to improve the patient’s quality of life.
Choice D rationale
The statement “This is not working and I plan to stop treatment” does not necessarily reflect an understanding of palliative care. While a patient has the right to stop treatment at any time, this decision should be based on a thorough understanding of their condition and the potential benefits and drawbacks of continuing or discontinuing treatment.

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A nurse is reviewing a fall risk assessment for a client. Which of the following findings place the client at risk for a fall? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client is newly diagnosed with relapsing-remitting multiple sclerosis (RRMS). What instruction should the nurse provide?

Correct Answer is B

Explanation

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Correct Answer is C

Explanation

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A nurse is reviewing a fall risk assessment for a client.
Which of the following findings place the client at risk for a fall? Select all that apply.