What expected physiological changes of the older adult put them at risk of falls? (Select all that apply).
Reduced muscle strength.
Sensory losses like vision and hearing.
Slowing of reflexes.
Dementia.
Inability to adapt.
Correct Answer : A,B,C
Reduced muscle strength, sensory losses like vision and hearing, and slowing of reflexes are all expected physiological changes of the older adult that can put them at risk of falls.
Reduced muscle strength can make it more difficult for older adults to maintain balance and stability.
Sensory losses like vision and hearing can affect an older adult’s ability to perceive their environment and navigate safely.
Slowing of reflexes can make it more difficult for older adults to react quickly to changes in their environment and prevent falls.
Choice D is not an answer because dementia is not a physiological change but rather a cognitive condition that can increase the risk of falls.
Choice E is not an answer because the inability to adapt is not a specific physiological change but rather a general characteristic that can increase the risk of falls.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Locking the wheels of the wheelchair is a priority action of the nurse to ensure client safety during a transfer from the bed to a wheelchair.
This prevents the wheelchair from moving or rolling away during the transfer, which could result in injury to the client.
Choice A is not an appropriate response because encouraging the client to push up from the wheelchair may not be safe or feasible for all clients.
Choice B is not an appropriate response because ensuring the client is bathed before getting into the wheelchair is not directly related to client safety during the transfer.
Choice D is not an appropriate response because placing the bed in the trendelenburg position could make it more difficult for the client to transfer
Correct Answer is B
Explanation
Temperature 97.0°F; pulse 54 bpm; respirations 14 breaths/minute; blood pressure 196/114 mmHg.
This set of vital signs is cause for concern because the blood pressure is significantly elevated.
A blood pressure reading of 196/114 mmHg is considered a hypertensive crisis and requires immediate medical attention.
Choice A) Temperature 96.9°F; pulse 100 bpm; respirations 20 breaths/minute; blood pressure 120/80 mmHg is within normal limits for an adult.
Choice C) Temperature 98.6°F; pulse 60 bpm; respirations 14 breaths/minute; blood pressure 110/66 mmHg is also within normal limits for an adult.
Choice D) Temperature 99°F; pulse 72 bpm; respirations 16 breaths/minute; blood pressure 100/60 mmHg is slightly elevated but not cause for immediate concern.
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