A nurse is assessing a client who reports hearing loss. Which of the following statements indicates that the hearing loss is affecting the client's ability to perform activities of daily living (ADLs)?

"l can't eat as much as I used to."

"l get dizzy when I nod my head."

"l wash my hair every other day."

"I walk my dog at least twice a day."

Answer and Explanation

The Correct Answer is B

A. "I can't eat as much as I used to": While changes in eating habits may be related to various factors, such as appetite changes or difficulty chewing/swallowing, this statement does not specifically indicate how hearing loss affects the client's ability to perform ADLs.

B. "I get dizzy when I nod my head": This statement suggests that the client is experiencing dizziness, which could be related to hearing loss affecting their sense of balance. Dizziness can significantly impact the client's ability to perform activities of daily living (ADLs) safely, such as walking, cooking, or bathing, as it increases the risk of falls and injury.

C. "I wash my hair every other day": This statement describes a personal hygiene habit and does not directly indicate how hearing loss affects the client's ability to perform ADLs.

D. "I walk my dog at least twice a day": This statement describes an activity the client engages in and does not directly indicate how hearing loss affects the client's ability to perform ADLs. Walking a dog does not necessarily require hearing ability, as it primarily involves physical movement and visual observation.

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Correct Answer is C

Explanation

A. Third spacing: Third spacing refers to the shifting of fluid from the intravascular space into the interstitial space, leading to decreased circulating volume. While third spacing can contribute to hypovolemic shock, it is not specific to obstructive shock.

B. Cardiomyopathy: Cardiomyopathy is a condition characterized by abnormalities in the heart muscle structure and function. While cardiomyopathy can lead to heart failure, it is not directly associated with obstructive shock.

C. Cardiac tamponade: Cardiac tamponade occurs when fluid accumulates in the pericardial sac, compressing the heart and impairing its ability to fill properly. This condition can lead to obstructive shock due to decreased cardiac output. Signs and symptoms include hypotension, muffled heart sounds, distended neck veins, and pulsus paradoxus.

D. Ruptured aneurysm: A ruptured aneurysm can lead to hypovolemic shock due to acute blood loss. While it can cause significant hemodynamic instability, it is not a characteristic diagnosis of obstructive shock.

A. I will need to massage my legs frequently to prevent a buildup of fluid B. I will keep my legs in a dependent position C. I will decrease my activity to prevent added stress on my legs D. I will inspect my legs every day for changes in color, size and temperature

Correct Answer is D

Explanation

A. Massaging the legs frequently can exacerbate symptoms of peripheral venous disease by increasing venous pressure and worsening edema. It is not recommended for managing this condition.

B. Keeping the legs in a dependent position can further impair venous return and exacerbate symptoms. Elevating the legs above the level of the heart when possible is recommended to reduce venous congestion.

C. Decreasing activity can lead to deconditioning and worsen symptoms over time. Encouraging regular, moderate physical activity is important for improving venous circulation and overall vascular health.

D. Inspecting the legs daily for changes in color, size, and temperature is an essential component of managing peripheral venous disease. Changes such as skin discoloration, swelling, or increased warmth can indicate worsening venous insufficiency or the development of complications such as venous ulcers. Early detection allows for prompt intervention and prevention of complications.

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A nurse is assessing a client who reports hearing loss. Which of the following statements indicates that the hearing loss is affecting the client's ability to perform activities of daily living (ADLs)?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is providing care for a client experiencing obstructive shock. Which of the following diagnoses should the nurse expect?

Correct Answer is C

Explanation

A nurse is teaching a client who has peripheral venous disease about management of symptoms. Which of the following client statements indicates to the nurse an understanding of the teaching?

Correct Answer is D

Explanation

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