A home health nurse is conducting a home safety assessment for an older adult client. Which of the following findings should the nurse identify as a safety risk for the client? (Select all that apply.)

Water heater temperature 54.4°C (130° F)

Throw rugs

Electric cords behind the furniture

Raised toilet seats

Bathtub with rails

Answer and Explanation

Correct Answer : A,B

A. A water heater temperature of 54.4°C (130°F) poses a burn risk, especially for older adults who may have decreased sensitivity to temperature changes. The recommended safe temperature for water heaters is usually around 49°C (120°F) to prevent scalding.

B. Throw rugs are a significant safety hazard as they can easily cause slips and falls, particularly for older adults who may have balance issues or mobility challenges.

C. Electric cords behind furniture do not pose an immediate tripping hazard, making this a lower safety risk compared to other options. However, cords should be checked for damage and overheating risks.
D. Raised toilet seats are typically considered a safety measure for older adults, as they can aid in sitting down and standing up, making it easier for individuals with mobility issues.

E. Bathtubs with rails are also a safety feature, providing support and stability for older adults when entering and exiting the tub, reducing the risk of falls.

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Correct Answer is C

Explanation

A. Measuring the gastric residual is a common practice before administering enteral feedings. It helps to assess if the client's stomach is emptying properly and if there is any buildup of undigested formula. This is important in identifying delayed gastric emptying, which can lead to complications if not addressed.
B. To remove gastric acid that might cause dyspepsia is not the primary purpose of measuring gastric residual. The main concern is to assess the rate of stomach emptying.
C. To confirm the placement of the NG tube is typically done using other methods, such as pH testing or an X-ray. While aspirating stomach contents through the tube can help confirm placement, it is not the primary purpose of measuring gastric residual.
D. To determine the client's electrolyte balance is not related to the purpose of measuring gastric residual. Electrolyte balance is typically assessed through blood tests and clinical signs and symptoms.

A. "Information about a client can be disclosed to family members at any time." B. "HIPAA is a federal law, not a state law." C. "A client's address would be an example of personally identifiable information." D. "HIPAA established regulations of individually identifiable health information in verbal, electronic, or written form."

Correct Answer is A

Explanation

A. This statement is incorrect. While HIPAA allows for certain disclosures to family members, it is important to follow specific guidelines and obtain appropriate consent or authorization from the client when sharing their health information. There are also circumstances where a client may request that information be withheld from certain family members.
B. This statement is correct. HIPAA is a federal law that establishes privacy standards for protected health information.
C. This statement is correct. A client's address is considered personally identifiable information under HIPAA.
D. The statement appears to be cut off. However, it is important to note that HIPAA does indeed establish regulations for protecting individually identifiable health information in various forms, including verbal, electronic, and written.

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A home health nurse is conducting a home safety assessment for an older adult client. Which of the following findings should the nurse identify as a safety risk for the client? (Select all that apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who receives intermittent enteral feedings through an NG tube. Before administering a feeding, the nurse should measure the gastric residual for which of the following purposes?

Correct Answer is C

Explanation

A nurse is reviewing information about the Health Insurance Portability and Accountability Act (HIPAA) with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates a need for further teaching?

Correct Answer is A

Explanation

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