A nurse is performing an annual wellness exam on an 8-year-old child whose last exam was one year ago. Which of the following findings should the nurse report to the provider?

Rationale:

A. Use a loud tone of voice when speaking with the client: Clients with visual impairments do not necessarily have hearing loss. Speaking loudly is unnecessary and may be perceived as disrespectful or startling. Clear, calm, and descriptive communication is more appropriate.

B. Rearrange client’s bedside table items frequently: Frequently moving personal items creates confusion and increases the risk of accidents or frustration for a visually impaired client. Consistent item placement enhances safety and independence.

C. Guide the client by walking parallel with them: Walking parallel without physical or verbal guidance may not be helpful. It’s more effective to offer the client your arm so they can follow your movement and safely navigate their surroundings.

D. Remove objects from client's path to the bathroom: Clearing obstacles from the client's walking path reduces the risk of tripping and falls. This is a key safety intervention for clients with reduced visual sensory perception and promotes independent, safe mobility.

Rationale:

A. A client who has heart failure and received a diuretic 30 min ago: While this client should be monitored for urine output and signs of dehydration or electrolyte imbalance, there is no indication of acute distress requiring immediate attention.

B. A client who has hypertension and reports a severe headache: This could indicate a hypertensive crisis or impending stroke, both of which are life-threatening and require urgent assessment and intervention to prevent neurological damage or organ failure.

C. A client who reports frequent and painful urination: These are signs of a urinary tract infection, which, while uncomfortable, is not typically emergent unless accompanied by fever, flank pain, or systemic symptoms.

D. A client who reports left arm pain following a fall: The arm pain may indicate a fracture, but it is less urgent than potential end-organ damage from a hypertensive emergency, assuming no deformity or vascular compromise is described.