A nurse is conducting a functional status assessment for an older adult client using the Lawton Instrumental Activities of Daily Living (IADLs) Scale. The nurse asks the client about his ability to use transportation.

Which of the following questions is appropriate for this domain?

The correct answer isA, B, C, and E.

The nurse should ask the client about medications, vision problems, home environment, and urinary incontinence as these are all factors that could contribute to falls in older adults.

• Medicationscan increase the risk of falls because they can cause side effects such as drowsiness, dizziness, confusion, or low blood pressure.Some medications that can increase the risk of falls include sedatives, antidepressants, antihypertensives, diuretics, and anticholinergics.

• Vision problemscan impair the ability to see obstacles, judge depth and distance, or adjust to changes in light.Some vision problems that can increase the risk of falls include cataracts, glaucoma, macular degeneration, and diabetic retinopathy.

• Home environmentcan pose safety hazards that can cause tripping, slipping, or losing balance.Some home hazards that can increase the risk of falls include loose rugs, clutter, poor lighting, slippery floors, uneven surfaces, and lack of handrails or grab bars.

• Urinary incontinencecan lead to rushed movements to the bathroom or frequent nighttime trips that can increase the risk of falls.Urinary incontinence can be caused by various factors such as bladder infections, prostate problems, pelvic floor weakness, or medication side effects.

Choice D is wrong because thyroid function is not a direct factor that contributes to falls in older adults.However, thyroid disorders such as hyperthyroidism or hypothyroidism can affect other factors such as muscle strength, bone density, heart rate, or blood pressure that can indirectly increase the risk of falls.

Normal ranges for thyroid function tests vary depending on the laboratory and the method used.However, a common reference range for thyroid-stimulating hormone (TSH) is 0.4 to 4.0 mIU/L and for free thyroxine (FT4) is 0.8 to 1.8 ng/dL.

The correct answer is D.

Report any signs of infection or delayed wound healing.

This is because oral hypoglycemic agents lower the blood glucose level, but they do not prevent the complications of diabetes mellitus, such as impaired wound healing and increased susceptibility to infections.Therefore, the client should be advised to monitor for any signs of infection, such as fever, redness, swelling, or pus, and report them to the health care provider promptly.

Choice A is wrong because checking blood glucose levels at least four times a day is not necessary for most clients who are taking oral hypoglycemic agents.

The frequency of blood glucose monitoring depends on the type and dose of medication, the level of glycemic control, and the presence of other factors that may affect blood glucose, such as illness or stress.The client should follow the individualized plan prescribed by the health care provider regarding blood glucose monitoring.

Choice B is wrong because drinking plenty of fluids and avoiding caffeine is not specific to clients who are taking oral hypoglycemic agents.

This is a general recommendation for all clients who have diabetes mellitus, as dehydration and caffeine can worsen hyperglycemia and increase the risk of diabetic ketoacidosis or hyperosmolar hyperglycemic state.However, this alone is not sufficient to manage diabetes mellitus and prevent complications.

Choice C is wrong because eating small, frequent meals and avoiding simple sugars is also a general recommendation for all clients who have diabetes mellitus, as this can help to maintain a stable blood glucose level and prevent hypoglycemia or hyperglycemia.

However, this alone is not sufficient to manage diabetes mellitus and prevent complications.The client should also follow a balanced diet that includes complex carbohydrates, protein, fiber, and healthy fats, and consult with a dietitian or a diabetes educator for individualized dietary guidance.