A home health nurse is assessing a client who has amyotrophic lateral sclerosis (ALS) and has had recent weight loss. Which of the following is the priority admission data for the nurse to obtain?

Changes in appetite

Prescribed medications

Daily fluid intake

wallowing ability

Answer and Explanation

The Correct Answer is D

A) Changes in appetite: While changes in appetite are important to assess, they are not the most immediate concern for a client with ALS who is experiencing weight loss. Appetite changes can contribute to weight loss, but other factors may be more critical.

B) Prescribed medications: Knowing the client’s prescribed medications is essential for overall care, but it is not the priority when addressing recent weight loss in a client with ALS. Medications can affect appetite and weight, but immediate physical concerns should be prioritized.

C) Daily fluid intake: Assessing daily fluid intake is important for hydration status, but it is not the priority in this scenario. Ensuring adequate fluid intake is necessary, but it does not directly address the potential complications related to weight loss in ALS.

D) Swallowing ability: Swallowing ability is the priority admission data to obtain for a client with ALS who has had recent weight loss. ALS can affect the muscles involved in swallowing, leading to dysphagia (difficulty swallowing). This can result in inadequate nutrition and hydration, as well as an increased risk of aspiration. Assessing swallowing ability helps identify the need for interventions such as dietary modifications, swallowing therapy, or alternative feeding methods to ensure the client’s safety and nutritional needs are met.

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Correct Answer is C

Explanation

A) Swaddle the newborn with his legs extended: This is not the appropriate way to swaddle a newborn. Swaddling should typically include flexing the legs to promote comfort and security, rather than extending them, which may be uncomfortable and less calming.

B) Maintain eye contact with the newborn during feedings: While establishing a bond with the newborn is important, excessive eye contact can overstimulate a newborn experiencing neonatal abstinence syndrome. The focus should be on creating a calming environment.

C) Minimize noise in the newborn's environment: This action is critical for a newborn experiencing neonatal abstinence syndrome, as these infants can be sensitive to stimuli. Reducing noise helps create a more soothing environment, which can alleviate symptoms of withdrawal.

D) Administer naloxone to the newborn: Naloxone is used to reverse opioid overdose, but it is not appropriate for routine treatment of neonatal abstinence syndrome. Management typically includes supportive care and, in some cases, pharmacologic treatment specific to the infant’s symptoms, rather than naloxone.

A. Amputation B. Osteoarthritis C. Primary glaucoma D. Hypertension

Correct Answer is D

Explanation

A) Amputation does not automatically disqualify someone from being a kidney donor, as the donor's overall health and kidney function are the primary concerns.

B) Osteoarthritis is not a contraindication for kidney donation, as this condition generally does not affect kidney function or the ability to undergo surgery.

C) Primary glaucoma is an eye condition that does not typically impact the decision to donate a kidney. The focus is primarily on the donor's renal function and overall health.

D) Hypertension can be a significant contraindication for kidney donation, especially if it is poorly controlled. Elevated blood pressure can increase the risk of complications during and after surgery and may affect the donor's long-term health, as they would have only one kidney. Therefore, this condition should be carefully evaluated before considering kidney donation.

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A home health nurse is assessing a client who has amyotrophic lateral sclerosis (ALS) and has had recent weight loss. Which of the following is the priority admission data for the nurse to obtain?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is developing a plan of care for a newborn whose mother tested positive for heroin during pregnancy. The newborn is experiencing neonatal abstinence syndrome. Which of the following actions should the nurse include in the plan?

Correct Answer is C

Explanation

A nurse is caring for a client who has end-stage kidney disease. The client's adult child asks the nurse about becoming a living kidney donor for their parent. Which of the following conditions in the child's medical history should the nurse identify as a contraindication to the procedure?

Correct Answer is D

Explanation

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