A nurse is teaching a client who has a history of falls about home safety. Which of the following statements should the nurse identify as an indication that the client understands the instructions?
"I will place a bath seat in my shower to use when I bathe."
"I will place an area rug at the entry of my bathroom."
"I will keep my walker at the end of my bed."
"I will keep the fluorescent ceiling light on in my room at night."
The Correct Answer is A
A. Placing a bath seat in the shower is a safety measure to prevent falls while bathing. This statement indicates an understanding of the importance of bathroom safety.
B. Placing an area rug at the entry of the bathroom can actually increase the risk of falls, as rugs can be tripping hazards. This statement does not demonstrate an understanding of home safety.
C. Keeping the walker at the end of the bed is a good practice for easy access, but it doesn't specifically address fall prevention in the home.
D. Keeping the fluorescent ceiling light on at night can provide better visibility and reduce the risk of tripping, but it doesn't address specific fall prevention measures elsewhere in the home.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Palpating the femoral pulse is an essential part of assessing the neurovascular status of a client with a femur fracture. The presence and strength of the femoral pulse can indicate adequate blood flow to the lower extremity.
B. While measuring the circumference of the thigh can provide some information about swelling or changes in the size of the limb, it does not directly assess neurovascular status.
C. Monitoring the client's calf for edema is important for assessing for signs of deep vein thrombosis (DVT) or venous insufficiency, but it is not the primary technique for assessing neurovascular status.
D. Instructing the client to wiggle his toes is a way to assess motor function and nerve function, which is part of the neurovascular assessment. However, it is not the initial step in assessing neurovascular status in a client with an unrepaired femur fracture. The femoral pulse should be assessed first to ensure adequate blood flow.
Correct Answer is D
Explanation
A. Ecchymosis of the distal foot may be expected after the application of a cast and is not necessarily an immediate concern unless it is severe or rapidly worsening.
B. Dependent edema distal to the cast can occur as a normal response to immobilization. It is not an immediate concern unless it is severe or associated with other concerning symptoms.
C. A moderate level of pain can be expected after the application of a cast. It should be managed appropriately, but it is not an immediate concern unless it is severe or uncontrolled.
D. Inability to flex the toes of the casted foot suggests a potential issue with circulation or nerve function, which requires immediate notification of the provider.
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