A home health nurse is conducting a home visit.

Exhibits

Click to highlight the findings that are risk factors for malnutrition in older adults. To deselect a finding, click on the finding again.

Nurses' Notes

Client is an older adult client with a history of osteoporosis, hypertension, and depression. Client is living independently with help of an aid for housekeeping and laundry. General appearance is neat, hair combed, clothing appropriate for weather. Skin color appropriate for ethnicity, overall skin is dry with bruising and small skin tear noted on knuckle of right hand. Dentures in glass on table. Client reports dentures don't fit well and make their mouth sore. Cough noted while client was drinking juice. Client reports appetite is decreased due to not being very hungry. Client reports eating mostly dinners that adult child prepares and freezes for them. Client states, "I just have to heat them up." Client also states. "Food just doesn't taste good anymore, and have a hard time chewing anything."

A nurse in a prenatal clinic is caring for a client. Using Leopold maneuvers, the nurse palpates a round, firm, moveable part in the fundus of the uterus and a long, smooth surface on the client's right side. In which abdominal quadrant should the nurse expect to auscultate fetal heart tones?

A nurse is preparing to administer methylnaltrexone 12 mg subcutaneously to a client who has opioid-induced constipation. Available is methylnaltrexone 8 mg/0.4 mL. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

A nurse is caring for a child who is on a clear liquid diet. At lunch, the child consumed 1/2 cup of juice, 3 oz gelatin, 1 oz of an ice pop, and 20 mL ginger ale. How many mL should the nurse record as the child's fluid intake?

A nurse in an urgent care clinic is studying the developmental stages of various clients. In which of the following clients should the nurse expect to see manifestations of autism?

A nurse is instructing a woman who is contemplating pregnancy about nutritional needs. To reduce the risk of giving birth to a newborn who has a neural tube defect, which of the following information should the nurse include in the teaching?

A nurse is providing teaching about Kegel exercises to a group of clients who are in the third trimester of pregnancy. Which of the following statements by a client indicates understanding of the teaching?

A nurse in the labor and delivery unit is caring for a client who is undergoing external fetal monitoring. The nurse observes that the fetal heart rate begins to slow after the start of a contraction, and the lowest rate occurs after the peak of the contraction. Which of the following actions should the nurse take first?

A nurse in a prenatal clinic is completing a skin assessment of a client who is in the second trimester. Which of the following findings should the nurse expect?

A nurse is caring for an 18-month-old toddler who has been hospitalized for 10 days. After the toddler's mother leaves the room, the nurse observes the toddler sitting quietly in the corner of the crib, sucking her thumb. When the nurse approaches the crib, the toddler turns away from the nurse. The nurse should understand that these behaviors indicate which of the following developmental reactions?

A nurse is providing home safety information for an older adult client who uses a cane. Which of the following statements should the nurse include in the teaching?