A nurse is assisting with the care of a client.

Exhibits
A nurse in a provider’s office is assisting with the review of fall risk data collected on a client. Which of the following findings places the client at risk for a fall? Select all that apply.

Uses a cane to ambulate.

Macular degeneration.

Grab bar in the bathroom

Electrical cord on floor over walkway.

Throw rugs over tile floors

Answer and Explanation

Correct Answer : B,D,E

Choice A reason : Using a cane to ambulate is generally a measure to improve stability and reduce the risk of falling for individuals who may have balance or mobility issues. It is not inherently a risk factor for falls; rather, it is a compensatory strategy to mitigate the risk of falls1.
Choice B reason : Macular degeneration can significantly impact visual acuity and contrast sensitivity, leading to difficulties in navigation and increasing the risk of tripping or misjudging distances. Poor vision is a well-documented risk factor for falls, especially in unfamiliar or complex environments.
Choice C reason : A grab bar in the bathroom is a safety device installed to provide stability and support for individuals while they are using the bathroom facilities. It is a preventive measure against falls and does not increase the risk of falling.
Choice D reason : An electrical cord on the floor over a walkway is a tripping hazard. It is a common home hazard that can cause falls, especially in the elderly or those with mobility and visual impairments78.
Choice E reason : Unsecured throw rugs over tile floors are a recognized fall hazard. They can easily slip underfoot or cause tripping if the edges are not secured, which is particularly dangerous in areas like the kitchen where spills can make the floor even more slippery.

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Correct Answer is A

Explanation

Choice A reason : Allow extra time to communicate with the client.Allowing extra time to communicate is essential when caring for clients with impaired speech. This approach respects the client's pace and supports their efforts to express themselves, which can be a time-consuming process. It also helps to reduce frustration and anxiety that the client may feel if rushed⁵.

Choice B reason : Ask open-ended questions.Asking open-ended questions to a client with impaired speech can be challenging for them to answer and may lead to frustration. Instead, it's recommended to ask yes/no questions or provide choices to facilitate easier communication⁵.

Choice C reason : Finish sentences for the client.Finishing sentences for a client with impaired speech is generally discouraged as it can lead to miscommunication and may make the client feel disempowered. It's important to allow the client to express themselves in their own words and time⁵.

Choice D reason : Avoid using visual aids for communication.Using visual aids can be very helpful for clients with impaired speech. Visual aids such as pictures, gestures, or writing can support understanding and expression, making communication more effective⁵.

A. Good boy-nice girl B. Punishment and obedience C. Law and order D. Social contract

Correct Answer is D

Explanation

Choice A reason : The "Good boy-nice girl" orientation is part of Kohlberg's Conventional level of moral development. In this stage, individuals are motivated by the desire to maintain relationships and gain approval from others. They make decisions based on what will please others and show concern for others by being "nice." This stage does not typically involve challenging rules but rather adhering to them to maintain social harmony⁴.

Choice B reason : The "Punishment and obedience" orientation is the first stage of Kohlberg's Preconventional level. Here, the focus is on direct consequences to the individual : actions are judged as good if they help avoid punishment. This stage is characterized by a literal obedience to rules and authority to avoid negative consequences, not by challenging them⁴.

Choice C reason : The "Law and order" orientation is the fourth stage, also within the Conventional level. In this stage, individuals are oriented to abiding by the law and respecting authority. They believe in maintaining the social order by following rules and laws. Challenging rules is not a characteristic of this stage; instead, there is a focus on upholding laws as they are⁴.

Choice D reason : The "Social contract" orientation is part of the Postconventional level of moral development, specifically the fifth stage. Individuals in this stage believe that rules and laws are flexible instruments for furthering human purposes. They can argue for the legality or principle behind the rule and may challenge rules that infringe on the rights of individuals. They understand that laws are created by people and can be changed by them. This stage involves the recognition that individual rights sometimes need to be upheld over and above the law⁴.

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A nurse is assisting with the care of a client. Exhibits A nurse in a provider’s office is assisting with the review of fall risk data collected on a client. Which of the following findings places the client at risk for a fall? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has impaired speech. Which of the following actions should the nurse take?

Correct Answer is A

Explanation

A nurse is assisting with teaching a class about Kohlberg's theory of moral development. The nurse should reinforce that which of the following stages involves challenging rules that impinge on the rights of others?

Correct Answer is D

Explanation

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A nurse is assisting with the care of a client. Exhibits A nurse in a provider’s office is assisting with the review of fall risk data collected on a client. Which of the following findings places the client at risk for a fall? Select all that apply.

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A nurse is assisting with the care of a client.

Exhibits
A nurse in a provider’s office is assisting with the review of fall risk data collected on a client. Which of the following findings places the client at risk for a fall? Select all that apply.