The nurse performs a functional assessment of a client upon admission to a home health service. The purpose of this assessment is to determine the
level of consciousness.
ability to perform activities of daily living
degree of reasoning, judgment, and thought processes.
level of functioning memory
The Correct Answer is B
A. It is typically part of a neurological or mental status examination rather than a functional assessment. Functional assessments are more concerned with how well a client can manage daily tasks and their overall ability to live independently.
B. The primary purpose of a functional assessment is to determine the client’s ability to perform activities of daily living (ADLs). ADLs include tasks such as bathing, dressing, grooming, eating, toileting, and mobility. This assessment helps to identify areas where the client may need assistance and guides the development of a care plan to support their independence and quality of life.
C. While assessing cognitive functions such as reasoning, judgment, and thought processes can be part of a comprehensive evaluation, it is not the primary goal of a functional assessment. These cognitive aspects are more relevant in mental status examinations or neuropsychological assessments.
D. Assessing memory is important for understanding cognitive function, but it is not the main focus of a functional assessment. Functional assessments are centered around evaluating practical abilities related to daily living rather than specific cognitive functions like memory.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Visual disturbances are not a common side effect of ECT. The more typical side effects of ECT include temporary memory loss, confusion, or headache. The patient should be informed about these potential side effects, but visual disturbances are not specifically associated with ECT.
B. Hydration is important for overall health, but it is not a specific requirement for ECT preparation. The primary preparation involves fasting, as patients are usually required to fast for several hours before the procedure to minimize the risk of aspiration during the treatment, as ECT is performed under anesthesia.
C. Incontinence is not a typical concern with ECT. The procedure itself does not usually result in incontinence. The focus should be more on preparing for potential side effects like temporary confusion
or memory issues, rather than concerns about incontinence. Therefore, this advice is not relevant for ECT preparation.
D. ECT involves the use of anesthesia, and patients should not drive themselves to or from the appointment due to the effects of anesthesia and the potential for temporary disorientation. Arranging for transportation ensures the patient’s safety and compliance with post-treatment care instructions.
Correct Answer is D
Explanation
A. Clarification is a crucial listening skill that involves asking questions or seeking additional information to ensure understanding. Avoiding clarification to prevent interruption can lead to misunderstandings and incomplete communication.
B. While it is important to be attentive and present during communication, taking notes can be necessary to document important information. The key is to balance note-taking with active listening. If done discreetly, note-taking should not significantly detract from the ability to engage in effective listening.
C. Finishing the client’s sentences can be perceived as interruptive and may come across as disrespectful or dismissive. It is important for the client to express their thoughts and feelings fully before the nurse responds.
D. Changing the environment to minimize distractions is a valuable listening skill. A quiet and comfortable setting can enhance effective communication by allowing the client to focus and express themselves without external interruptions. This helps ensure that the nurse can fully concentrate on the client’s message and respond appropriately.
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