Which skill should the nurse have an older client demonstrate to evaluate the ability to perform activities of daily living (ADL)?
Telephoning a family member.
Opening a bar soap package.
Sorting a collection of socks.
Reading a short paragraph.
The Correct Answer is B
Answer: B. Opening a bar soap package.
Rationale:
A) Telephoning a family member:
Using a telephone is considered an instrumental activity of daily living (IADL), which involves more complex tasks required for independent living, such as managing communication. While important, it does not directly assess the physical and motor skills required for basic self-care.
B) Opening a bar soap package:
Opening a bar soap package involves fine motor skills and hand coordination, which are necessary for performing basic activities of daily living (ADLs). ADLs refer to essential self-care tasks like bathing, dressing, and grooming. Being able to open soap indicates the client has the dexterity needed for personal hygiene.
C) Sorting a collection of socks:
Sorting socks is more cognitive than motor-oriented, and it assesses organization skills, which are more aligned with IADLs rather than ADLs. It does not specifically evaluate the client’s ability to perform tasks related to basic self-care.
D) Reading a short paragraph:
Reading a paragraph evaluates literacy or cognitive function but is not directly related to performing ADLs. ADLs focus on physical activities necessary for daily living, such as dressing, eating, or bathing.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["C","D","E"]
Explanation
Answer: C. Age when the client started smoking.
Knowing when the client began smoking is essential for determining the total duration of smoking. This information allows the nurse to calculate how long the client has been exposed to tobacco, which is critical for assessing potential health risks associated with their smoking history.
D. Packs of cigarettes smoked per day.
This information is crucial as it directly contributes to the calculation of pack years. Understanding how many packs the client smokes each day helps quantify their level of tobacco exposure. For instance, smoking one pack per day for ten years results in ten pack years, while two packs per day over the same period would lead to twenty pack years.
E. Number of years the client smoked.
This detail is necessary to determine the total duration of the smoking habit. The total number of years smoked, combined with the daily pack consumption, provides a comprehensive view of the client's smoking history. It allows the nurse to assess the cumulative risk associated with long-term tobacco use, which is important for evaluating the client’s health and potential interventions.
Rationale for Options Not Selected:
A. Number of attempts to quit smoking.
While this information can provide insight into the client's motivation and efforts to quit, it is not relevant for calculating pack years. Pack years focus specifically on the amount and duration of smoking, rather than attempts to quit, which may be useful in assessing readiness for cessation interventions but does not factor into the calculation of exposure.
B. Client's current age.
Although the client's age can provide context regarding their smoking history, it is not necessary for the actual calculation of pack years. Instead, it is the age when the client started smoking, along with the total years smoked and the number of packs smoked per day, that are critical for this specific assessment. The current age is not needed to compute pack years directly.
Summary of Calculation:
To calculate pack years, use the formula:
- Pack Years = (Number of packs smoked per day) × (Number of years smoked)
For example, if a client smoked 1 pack per day for 20 years, they would have 20 pack years. If they smoked 2 packs a day for the same period, that would equate to 40 pack years. This measurement is essential for understanding the health risks associated with smoking and guiding further assessment and intervention strategies.
Correct Answer is D
Explanation
A. Deep, continuous pain in the calf muscles:
Deep, continuous pain in the calf muscles is more indicative of conditions such as deep vein thrombosis (DVT) rather than venous insufficiency.
B. Painful symptoms alleviated by warmth:
Painful symptoms alleviated by warmth are more characteristic of arterial insufficiency, such as in peripheral arterial disease (PAD), rather than venous insufficiency.
C. Cool, pale skin below the knees:
Cool, pale skin below the knees is also more suggestive of arterial insufficiency rather than venous insufficiency. Arterial insufficiency often presents with decreased blood flow to the extremities, resulting in coolness and pallor.
D. Decreased pain when legs are elevated:
This is the correct answer. Venous insufficiency typically results in symptoms such as aching, tired legs, and swelling, which worsen with prolonged standing but improve with leg elevation. This is due to the reduction in venous pressure when the legs are elevated, which helps alleviate symptoms associated with venous congestion and stasis.
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