A nurse is assessing an older adult patient who is experiencing age-related changes.
Which of the following findings should the nurse expect?
Increased joint stiffness
Increased muscle mass
Increased calcification of bones
Decreased balance
The Correct Answer is A
Choice A rationale
Increased joint stiffness is a common age-related change in older adults.
Choice B rationale
Increased muscle mass is not typically an age-related change. In fact, older adults often experience a decrease in muscle mass, a condition known as sarcopenia.
Choice C rationale
Increased calcification of bones is not a typical age-related change. Older adults are more likely to experience osteoporosis, a condition characterized by a decrease in bone density.
Choice D rationale
Decreased balance is a common age-related change, but it is not the correct answer for this question.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
While it’s important for the client to understand the alternatives to the procedure, it’s typically the responsibility of the physician or surgeon to explain these alternatives, not the nurse.
Choice B rationale
One of the nurse’s responsibilities in the informed consent process is to confirm that the client is competent to sign for the procedure. This means ensuring that the client understands the procedure, its risks and benefits, and is making the decision voluntarily.
Choice C rationale
Discussing the risks of the procedure with the client is typically the responsibility of the physician or surgeon, not the nurse.
Choice D rationale
While the nurse may provide some information about what will occur during the procedure, it’s typically the responsibility of the physician or surgeon to provide detailed information about the procedure.
Correct Answer is C
Explanation
Choice A rationale
Checking the patient’s visual acuity using a Snellen chart is used to assess cranial nerve II (Optic), not cranial nerve XI (Spinal Accessory)3.
Choice B rationale
Whispering in one of the patient’s ears while blocking the other is a method used to assess cranial nerve VIII (Vestibulocochlear), not cranial nerve XI4.
Choice C rationale
Observing the patient’s ability to turn their head from side to side is a correct method to assess cranial nerve XI. This nerve innervates the sternocleidomastoid and trapezius muscles, which are responsible for turning the head and shrugging the shoulders respectively.
Choice D rationale
Asking the patient to identify specific smells is used to assess cranial nerve I (Olfactory), not cranial nerve XI3.
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