A nurse is collecting data on the mobility of a client. Which of the following actions should the nurse take first?
Ask the client to stand for 5 seconds.
Ask the client to place their feet on the floor.
Ask the client to sit on the edge of the bed for 2 min.
Ask the client to march in place.
The Correct Answer is C
A) Standing requires more mobility and strength; it's not the first step in assessing mobility.
B) Placing feet on the floor assesses the client's ability to follow instructions and indicates readiness for further mobility assessments but is not the first step compared to sitting on the edge of the bed for 2 minutes.
C) This is the first action that the nurse should take to assess the client's mobility and balance. Sitting on the edge of the bed for 2 min allows the nurse to observe the client's posture, strength, coordination, and ability to maintain equilibrium.
D) This is a more advanced mobility assessment and should come after basic assessments like placing feet on the floor.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A) The lens tends to become less flexible with age, affecting accommodation.
B) The lens may become thicker with age, contributing to presbyopia.
C) Age-related changes such as decreased pupil size and changes in visual acuity can lead to reduced depth perception.
D) Aging can lead to decreased muscle tone, including in the eye muscles, which may affect accommodation and focus.
Correct Answer is A
Explanation
A) Increasing fruit intake can provide dietary fiber, which helps promote bowel regularity and prevent constipation.
B) Encouraging the client to drink cold fluids is not specifically indicated for constipation.
C) While mineral oil may be used as a laxative, it is not typically a first-line intervention and may not be appropriate for all clients.
D) A low-fiber diet is likely to exacerbate constipation rather than alleviate it.
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