A nurse is assessing an older adult client. Which of the following statements indicates that the client is at a risk for being socially isolated?

"People have to speak louder for me to hear when they visit."

"I only babysit my grandchildren twice each month."

"My hearing aid is lost, so I don't go to church like I used to do."

"My adult child takes me to the grocery store every other week."

Answer and Explanation

The Correct Answer is C

A. Hearing difficulties can be a challenge but do not necessarily indicate social isolation unless they lead to withdrawal from activities.
B. Babysitting twice a month still allows for social interaction and does not suggest isolation.
C. Not attending church due to a lost hearing aid suggests withdrawal from social activities, which increases the risk of social isolation.
D. Having a family member assist with grocery shopping indicates some level of social interaction and support, reducing the risk of isolation.

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Correct Answer is D

Explanation

A. Scant lochia rubra with a few small clots. Lochia rubra is expected in the early postpartum period, and small clots are normal unless excessive bleeding occurs.
B. Urine output 2,500 mL/day. Increased urine output is expected postpartum as the body eliminates excess fluid retained during pregnancy.
C. Bilateral ankle edema. Mild edema is common postpartum due to fluid shifts and typically resolves on its own.
D. 4+ deep-tendon reflexes. Hyperreflexia is a sign of central nervous system irritability and may indicate preeclampsia, which requires immediate evaluation.

A. A bologna sandwich on rye bread B. Whole wheat pasta with shrimp C. A corn tortilla with black beans D. Low sodium vegetable soup with barley

Correct Answer is C

Explanation

A. A bologna sandwich on rye bread. This is incorrect because rye bread contains gluten, which must be avoided in a celiac disease diet.
B. Whole wheat pasta with shrimp. This is incorrect because whole wheat pasta contains gluten, making it unsuitable for a child with celiac disease.
C. A corn tortilla with black beans. This is correct because corn tortillas are naturally gluten-free, and black beans provide a nutritious, safe option for a child with celiac disease.
D. Low sodium vegetable soup with barley. This is incorrect because barley contains gluten, making it inappropriate for a celiac-friendly diet.

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A nurse is assessing an older adult client. Which of the following statements indicates that the client is at a risk for being socially isolated?

Nursing Test Bank

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