When caring for the elderly the nurse must implement which measure for client safety?
Keep the environment free of obstacles
Raise the bed for client ease upon exiting
Avoid bright lighting
Keep linens away from nursing uniform
The Correct Answer is A
A. This is essential to prevent falls, which are a common and serious risk for the elderly. A clutter-free environment allows for safe and easy mobility.
B. Raising the bed, can actually increase the risk of falls if the bed is too high for safe exit.
C. Bright lighting can cause glare and visual discomfort for elderly individuals, especially those with age- related eye conditions such as cataracts or macular degeneration. However, adequate lighting is crucial for safety. The key is to provide sufficient lighting that is evenly distributed and free of glare or harsh shadows, which can help prevent falls.
D. While keeping linens away from the nursing uniform is good practice for infection control, it does not directly relate to the immediate physical safety of the client in the same way that a clear environment does.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
B. Heard over most of the lung fields, except for the major bronchi and the trachea.
Low intensity and pitch, with a longer inspiratory phase than expiratory phase. They are softer and more breezy in quality. Vesicular breath sounds are heard over the peripheral lung fields, including the apex (top) of the lungs.
A. Heard over the major bronchi, which are near the sternum and between the scapulae. They are of intermediate intensity and pitch, with equal inspiration and expiration phases. They are typically heard in the 1st and 2nd intercostal spaces along the sternal border and between the scapulae.
C. Heard over the trachea and larynx.
Characteristics: High intensity and pitch, with a short inspiratory phase and a longer expiratory phase. They are louder and harsher in quality, resembling the sound of air blowing through a hollow pipe.
D. Crackles are abnormal breath sounds that can be fine or coarse.
Fine crackles are high-pitched, short, popping sounds heard during inspiration, often due to fluid in the small airways or alveoli.
Coarse crackles are loud, low-pitched, bubbling sounds heard during inspiration, typically due to the presence of secretions in the larger airways.
Correct Answer is ["A","B","C","D","E"]
Explanation
A. Previous experiences with pain can significantly influence how individuals perceive and respond to pain in the future. Positive experiences may lead to better coping strategies, while negative experiences could increase fear and anxiety associated with pain.
B. Cultural beliefs, norms, and practices surrounding pain vary widely across different societies. Culture shapes how individuals express pain, interpret pain severity, and seek treatment. For instance, some cultures may encourage stoicism in the face of pain, while others may emphasize the importance of verbalizing discomfort.
C. Socioeconomic status can impact access to healthcare resources, including pain management options. Higher SES individuals may have better access to healthcare facilities, medications, and therapies, whereas lower SES individuals may face barriers to adequate pain relief due to financial constraints or limited healthcare services.
D. Emotional states such as anxiety, depression, stress, and fear can significantly influence the perception and experience of pain. These emotions can amplify pain perception and interfere with pain management strategies. Conversely, positive emotions and a sense of well-being may help reduce the intensity of pain.
E. Age-related factors can affect how pain is perceived and managed. Children and older adults, for example, may experience pain differently due to developmental stages, cognitive abilities, and physiological changes. Pain assessment and management approaches need to be tailored accordingly to address age-specific considerations.
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