A nurse is assessing a client who is using crutches as an assistive device due to a right hip fracture. Which of the following actions should the nurse take prior to planning the client's care?

Observe the client's ability to keep their elbows extended when using the crutches.

Instruct the client to lean forward when using the crutches.

Observe the client's gait pattern when using the crutches.

Ensure the client's weight is placed on their axilla area when using the crutches.

Answer and Explanation

The Correct Answer is C

A. Observe the client's ability to keep their elbows extended when using the crutches: The elbows should be slightly flexed, not fully extended, when using crutches. Observing for elbow extension is incorrect and could indicate improper technique. Proper elbow positioning is assessed as part of gait evaluation rather than as a standalone measure.

B. Instruct the client to lean forward when using the crutches: Leaning forward places excessive pressure on the axillae and increases the risk of nerve injury. Clients should maintain an upright posture while using crutches, so this instruction is unsafe and should not be included in care planning.

C. Observe the client's gait pattern when using the crutches: Observing the gait pattern allows the nurse to assess how the client distributes weight, coordinates movements, and uses the crutches safely. This assessment is essential prior to planning care and interventions, ensuring that the client can ambulate safely and independently.

D. Ensure the client's weight is placed on their axilla area when using the crutches: Weight should be supported by the hands and arms, not the axillae, to prevent nerve damage. Ensuring proper weight distribution is part of teaching and assessment, but placing weight on the axillae is incorrect and unsafe.

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Correct Answer is A

Explanation

A. Syphilis: Syphilis is a nationally notifiable disease in the United States. Healthcare providers are required to report cases to local or state public health authorities to facilitate disease tracking, outbreak management, and public health interventions.

B. Trichomoniasis: Trichomoniasis is not a nationally notifiable disease. While it is a common sexually transmitted infection, reporting is not required by law at the national level, though some states may have local reporting requirements.

C. Genital herpes: Genital herpes is not nationally reportable because it is highly prevalent and often managed in outpatient settings without mandatory reporting. Surveillance focuses on population studies rather than individual case reporting.

D. Human papillomavirus (HPV): HPV infections are not nationally notifiable. Although HPV is common and associated with cancers, individual cases are not reported to public health authorities. Reporting is limited to cancer registries for HPV-related malignancies.

A. Unilateral leg swelling B. Increased hemoglobin C. Increased urinary output D. Mild pain at the surgical site

Correct Answer is A

Explanation

A. Unilateral leg swelling: Swelling in one leg following surgery may indicate deep vein thrombosis (DVT), a serious postoperative complication. DVT can lead to life-threatening pulmonary embolism if untreated, so early recognition and intervention are crucial in the post-hysterectomy period.

B. Increased hemoglobin: An increase in hemoglobin is not typically associated with postoperative complications. It may occur due to hemoconcentration but is not a red flag for immediate concern after surgery.

C. Increased urinary output: Increased urinary output is usually not indicative of a complication following hysterectomy. Abnormal urinary patterns of concern would include decreased output, dysuria, or signs of infection rather than an increase in volume.

D. Mild pain at the surgical site: Mild pain is an expected finding after a hysterectomy and is part of the normal healing process. Pain that is manageable with prescribed analgesics does not indicate a complication.

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A nurse is assessing a client who is using crutches as an assistive device due to a right hip fracture. Which of the following actions should the nurse take prior to planning the client's care?

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