A nurse is instructing a client who has left-sided hemiparesis about the use of a quad cane. Which of the following actions by the client indicates an understanding of the teaching?
The client advances their right foot to meet their left foot.
The client maintains two points of support on the floor.
The client holds the cane in their left hand.
The client moves the cane forward 50.8 cm (20 in) when ambulating.
The Correct Answer is B
B. When using a quad cane, the client should always maintain two points of support on the floor: the cane and either the affected (left) or unaffected (right) leg. This ensures stability and support while walking.
A When using a quad cane, the client should advance their weaker (left) foot and then the stronger (right) foot. This allows the cane to provide support on the weaker side.
C. This action is correct for a client with left-sided hemiparesis. The quad cane should be held on the stronger side (right hand) to provide support for the weaker side (left leg).
D. This statement is unclear in terms of the context provided. However, typically when using a quad cane, the cane is moved forward a comfortable distance with each step to provide continuous support and balance. The exact distance may vary depending on the client's stride length and comfort.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
C. Cool, clammy skin is a common symptom of hypoglycemia. When blood sugar levels drop too low, the body's sympathetic nervous system is activated, causing sweating and cool, clammy skin as a response to the stress of low blood sugar.
A Kussmaul respirations are deep, rapid, and labored breathing patterns that occur in response to diabetic ketoacidosis (DKA), a complication of hyperglycemia rather than hypoglycemia. In hypoglycemia, the body typically responds with normal or shallow respirations.
B Increased urine output (polyuria) is more commonly associated with hyperglycemia, where the kidneys try to excrete excess glucose through urine. Hypoglycemia typically does not cause increased urine output.
D. Acetone breath, which has a fruity odor, is associated with diabetic ketoacidosis (DKA), a condition caused by severe hyperglycemia and metabolic acidosis. It is not a typical finding in hypoglycemia.
Correct Answer is B
Explanation
B. Asking the client if they feel like they have food stuck at the base of their throat directly assesses for the hallmark symptom of dysphagia associated with achalasia. This symptom is crucial in diagnosing and monitoring the condition.
A This question assesses for symptoms of esophageal reflux (heartburn), which may not directly relate to the mechanical difficulty of swallowing associated with oral achalasia.
C. This question focuses on sensations of fullness in the neck, which may not specifically relate to swallowing difficulty associated with achalasia.
D. This question assesses for pain during swallowing, which can occur in conditions affecting the throat or esophagus, but it does not specifically address the unique symptom of feeling like food is stuck, which is more typical in achalasia.
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