The nurse is obtaining a health history for a client being admitted for new onset seizures. Which action should the nurse implement to accurately record the health history findings?

Enter subjective data in the note section of the client's electronic medical record.

Document the client's history that is directly related to current admission diagnoses.

Enter the information in the electronic medical record at the client's bedside.

Document the assessment findings on the computer at the nursing station.

Answer and Explanation

The Correct Answer is B

A.   While subjective data is important, it should be categorized appropriately based on relevance to the diagnosis, not just placed in the notes section without context.
B.   Documenting the client’s history directly related to the current admission diagnoses ensures the information is relevant and addresses the issue at hand. It helps prioritize concerns specific to the new onset seizures.
C.   Recording at the bedside can be useful for accuracy but is not as effective for thoroughness as
entering information directly in the client’s electronic medical record with appropriate organization.
D.   Documenting assessment findings at the nursing station might delay real-time recording and cause the information to be less accurate, especially if not recorded immediately after assessment.

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Correct Answer is C

Explanation

A. A lifestyle with minimal physical activity may contribute to general health issues, but it is not as directly linked to erectile dysfunction as conditions like diabetes.
B. Working long hours can cause stress or fatigue, which may indirectly affect sexual function, but it is not a direct cause of erectile dysfunction.
C. Type 2 diabetes mellitus is a well-known risk factor for erectile dysfunction due to its impact on blood flow and nerve function, both of which are essential for normal erectile function.
D. A phosphodiesterase inhibitor is often used to treat erectile dysfunction, but its presence on the medication list is more likely a treatment rather than a cause.

A. Tenting noted in subclavicular area. B. Loss of skin elasticity in the hand. C. Skin is warm and dry. D. Thinning hair in the lower extremities.

Correct Answer is A

Explanation

A. Skin tenting is a sign of dehydration. It occurs when the skin, after being pinched, does not quickly return to its normal position. This is often seen in areas with loose skin such as the subclavicular region.
B. Loss of skin elasticity is a normal aging process and not specifically indicative of dehydration. It can be seen in older adults regardless of hydration status.
C. Warm and dry skin can be a sign of dehydration. Dehydration leads to reduced sweating, which can result in dry skin, and it may also increase the body temperature, making the skin feel warm.
D. Thinning hair, especially in the lower extremities, is typically associated with circulatory issues or aging. It is not a direct sign of dehydration.

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The nurse is obtaining a health history for a client being admitted for new onset seizures. Which action should the nurse implement to accurately record the health history findings?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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Correct Answer is A

Explanation

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