During a home visit, the nurse observes an elderly patient trying to walk to the bathroom. The patient appears unstable and clings to furniture while refusing any help.
What action should the nurse take?
Suggest that the patient get a walker.
Encourage the patient to acquire a medical alert device.
Ensure the patient’s privacy while in the bathroom.
Identify potential safety hazards in the home.
The Correct Answer is D
Answer and explanation
The correct answer is Choice D.
Choice A rationale
While suggesting that the patient get a walker might help with mobility, it does not directly address the safety concerns in the home environment.
Choice B rationale
A medical alert device could be beneficial in case of emergencies, but it does not prevent the risk of falls or accidents in the home.
Choice C rationale
Ensuring the patient’s privacy is important, but it does not address the immediate safety concerns observed by the nurse.
Choice D rationale
Identifying potential safety hazards in the home is the most immediate and effective action the nurse can take. By doing this, the nurse can work with the patient and their family to make necessary changes to improve safety and prevent falls.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Answer and explanation The correct answer is C. Choice A rationale
Delineating the geographic distribution of the area to survey and review for patterns could provide useful information about the spread of influenza in the community, but it would not directly provide data about vaccination rates or reasons for any decline.
Choice B rationale
Asking a set number of clients if they have had the flu could provide anecdotal information about the prevalence of the flu, but it would not provide comprehensive data about vaccination rates or reasons for any decline.
Choice C rationale
Generating influenza immunization and case reports from the electronic record would provide direct data about the number of people who have been vaccinated and the number of influenza cases. This information could be used to identify trends and understand reasons for any decline in vaccination rates.
Choice D rationale
Determining the change in immunization rates from the previous year to the current year would provide information about trends in vaccination rates, but it would not provide comprehensive data about the number of influenza cases or reasons for any decline.
Correct Answer is D
Explanation
Answer and explanation
The correct answer is Choice D.
Choice A rationale
While older adults living in subsidized housing near an airport may have exposure to various environmental hazards, lead poisoning is not typically associated with these conditions. Lead poisoning is more commonly associated with exposure to lead-based paint, which is often found in older homes.
Choice B rationale
Young adults who frequently camp and hike in remote desert areas are not typically at high risk for lead poisoning. Lead exposure is more commonly associated with certain occupational environments and older residential buildings.
Choice C rationale
While a diet high in fish and other seafood can expose individuals to certain environmental contaminants, lead poisoning is not typically associated with these food sources. Lead exposure is more commonly associated with certain occupational environments and older residential buildings.
Choice D rationale
Families with young children living primarily in 100-year-old farmhouses would likely benefit most from a lead poisoning education and screening program. Older homes, particularly those built before 1978, often contain lead-based paint, which can pose a significant risk for lead poisoning, especially in young children.
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