A community health nurse is performing a home visit for a client and is evaluating the home environment for safety. Which of the following findings would indicate to the nurse that the client has a proper understanding of safety in the home?

A small area rug is placed at the front door.

The water heater is set at 54° C (129.2° F).

The batteries in the smoke alarms are changed annually.

A single light fixture hangs along the sidewalk to the house.

Answer and Explanation

The Correct Answer is C

Rationale:

A. A small area rug is placed at the front door: Area rugs increase the risk of falls, especially in older adults or clients with mobility issues. Rugs should be removed or secured with non-slip backing to prevent tripping hazards at entrances and high-traffic areas.

B. The water heater is set at 54° C (129.2° F): This temperature is too high and poses a significant risk for burns or scalding. The recommended maximum water heater setting for safety is 49° C (120° F), especially in homes with children or older adults.

C. The batteries in the smoke alarms are changed annually: Changing smoke alarm batteries once a year aligns with fire safety recommendations. Functioning smoke alarms are a critical part of home safety and fire prevention.

D. A single light fixture hangs along the sidewalk to the house: One light may not provide adequate visibility, especially in poor weather or at night. Multiple, evenly spaced light sources are more effective for preventing trips or falls along walkways.

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Correct Answer is D

Explanation

Rationale:

A. "Client in room 303 is requesting snacks between meals.": While client preferences are important, this information is non-urgent and can be communicated through care plans or written notes. It does not directly impact immediate nursing care during a shift change.

B. "Client in room 304 has a laptop that they use for relaxation.": This is personal, non-clinical information and is not essential for safe and effective handoff communication. Shift reports should focus on medical status, treatment plans, or immediate needs.

C. "Client in room 302 has multiple visitors.": Visitor status is not a priority item in a shift report unless it directly affects client care, safety, or monitoring. Including such information can distract from more clinically significant updates.

D. "Client in room 301 is in the cardiac catheterization lab.": This is critical information because it reflects a current procedure, potential risks, and possible post-procedure care needs. Reporting this ensures continuity of monitoring and prioritization.

A. Polydipsia B. Tremors C. Acetone breath odor D. Inability to concentrate E. Diaphoresis

Correct Answer is ["B","D","E"]

Explanation

Rationale:

A. Polydipsia: Polydipsia, or excessive thirst, is commonly associated with hyperglycemia due to osmotic diuresis caused by high blood glucose levels. It is not a typical feature of hypoglycemia.

B. Tremors: Tremors are a hallmark symptom of hypoglycemia. They result from the body's adrenergic (sympathetic) response to low blood glucose levels, which triggers the release of epinephrine to raise glucose.

C. Acetone breath odor: A fruity or acetone breath odor is associated with diabetic ketoacidosis, a complication of hyperglycemia, not hypoglycemia. It indicates ketone buildup due to fat metabolism in the absence of insulin.

D. Inability to concentrate: Cognitive impairment, such as confusion or difficulty concentrating, is a neurological symptom of hypoglycemia. The brain relies heavily on glucose, and low levels affect its function quickly.

E. Diaphoresis: Sweating is a common autonomic symptom of hypoglycemia due to activation of the sympathetic nervous system. It often occurs early in a hypoglycemic episode and is a critical sign to monitor.

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A community health nurse is performing a home visit for a client and is evaluating the home environment for safety. Which of the following findings would indicate to the nurse that the client has a proper understanding of safety in the home?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

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Correct Answer is ["B","D","E"]

Explanation

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