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?

Swallowing ability

Changes in appetite

Prescribed medications

Daily fluid intake

Answer and Explanation

The Correct Answer is A

A: Swallowing ability is crucial because ALS often leads to dysphagia, which can cause weight loss due to difficulty eating and the risk of aspiration.
B: Changes in appetite are important but secondary to physical ability to eat safely.

C: While knowing about prescribed medications is necessary, it does not directly address the issue of weight loss as critically as swallowing ability.
D: Fluid intake is important but the priority is assessing the ability to swallow safely, which directly impacts nutritional status.

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Correct Answer is C

Explanation

A. Informing the client that the transfusion is mandatory disregards the client's autonomy and right to refuse treatment.
B. While documenting the client's refusal is important, notifying risk management about the refusal is not necessary unless there are specific facility policies or legal requirements.
C. Documenting the client's refusal in the medical record ensures that the refusal is properly recorded and communicated to the healthcare team, protecting both the client's autonomy and the healthcare provider.
D. While it's important to respect the client's autonomy, suggesting alternative therapies may not be appropriate in this context and could undermine the client's decision-making process.

A. 8.1% B. 15.9% C. 13.3% D. 7.5%

Correct Answer is D

Explanation

A. To calculate the weight loss percentage, divide the weight lost by the original weight: 6.8/90.7 X 100 = 7.497% = 7.5 % (Rounded off to the nearest tenth)
B. To calculate the weight loss percentage, divide the weight lost by the original weight: 6.8/90.7 X 100 = 7.497% = 7.5 % (Rounded off to the nearest tenth)
C. To calculate the weight loss percentage, divide the weight lost by the original weight: 6.8/90.7 X 100 = 7.497% = 7.5 % (Rounded off to the nearest tenth)
D. To calculate the weight loss percentage, divide the weight lost by the original weight: 6.8/90.7 X 100 = 7.497% = 7.5 % (Rounded off to the nearest tenth)

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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

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Correct Answer is D

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