A client is discharged to home following hospitalization for percutaneous endoscopic gastrostomy tube placement to assist with nutrition. The client's primary diagnosis is amyotrophic lateral sclerosis (ALS). The client can transfer from the bed to a chair but can't walk.
The client and their family are concerned about the client's ability to maintain mobility at the highest possible level following a surgical procedure. The nursing diagnosis most appropriate for this client is ...
Impaired physical mobility related to decreased motor agility secondary to ALS as manifested by inability to ambulate.
Hopelessness related to impaired ability to cope.
Caregiver role strain related to care recipient's unrealistic expectations of caregiver.
Impaired memory related to reduced quality and quantity of information processed.
The Correct Answer is A
Choice A rationale: In ALS, impaired physical mobility due to decreased motor agility and the inability to ambulate is a direct consequence of the disease.
Choice B rationale: Hopelessness might be a possible emotional response but doesn't address the client's physical limitations due to ALS.
Choice C rationale: Caregiver role strain is related to the family's ability to manage caregiving responsibilities and is not the primary concern for the client's physical mobility.
Choice D rationale: Impaired memory is not the primary issue in ALS; the client's inability to ambulate due to decreased motor function is the main focus for this nursing diagnosis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale: BSE will not reduce the risk of dying from breast cancer, but it may help you detect breast cancer earlier, when it is more treatable.
Choice B rationale: BSE should be done once a month, preferably at the same time each month. For women who have menstrual periods, the best time to do BSE is a few days after the period ends, when the breasts are less tender and swollen. For women who do not have menstrual periods, such as those who are pregnant, breastfeeding, or postmenopausal, they can choose a fixed date, such as the first day of each month, to do BSE.
Choice C rationale: For women who have menstrual periods, the best time to do BSE is a few days after the period ends, when the breasts are less tender and swollen. For women who do not have menstrual periods, such as those who are pregnant, breastfeeding, or postmenopausal, they can choose a fixed date, such as the first day of each month, to do BSE.
Choice D rationale: Annual mammograms are recommended for women aged 40 and older, or earlier if they have a high risk of breast cancer and not all women. Women aged less than 30 years should undergo breast ultrasound instead.
Correct Answer is B
Explanation
Choice A rationale: This test is not specific for confirming osteoporosis.
Choice B rationale: This test is called a bone mineral density (BMD) test or a dual-energy X-ray absorptiometry (DXA) scan. It measures how much calcium and other minerals are in a segment of bone.
Choice C rationale: This test is not specific for confirming osteoporosis.
Choice D rationale: This test is not specific for confirming osteoporosis.

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