A nurse is performing an assessment of an older adult client in an assisted living facility.
Which of the following findings is the highest priority for the nurse to address when planning care?
Unsteady gait
Report of short-term memory loss
Hearing loss
Report of frequent constipation
The Correct Answer is A
A. An unsteady gait increases the risk of falls, which can lead to serious injuries in older adults.
A. Ensuring safety and preventing falls is a priority.
B. Short-term memory loss is common in older adults, but it may not pose an immediate risk to safety.
C. Hearing loss, while important, may not be an immediate safety concern unless it significantly impacts the individual's ability to communicate or hear warnings.
D. Frequent constipation is a common concern in older adults but may not pose an immediate threat to safety. Falls prevention takes precedence in this scenario.
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Related Questions
Correct Answer is C
Explanation
A. Controlled substances typically require a licensed nurse or provider to witness the wasting, not assistive personnel.
B. Wasted medication should be disposed of according to facility policies but not necessarily in a sharps container unless it is a sharp object.
C. Recording the amount of medication wasted on the controlled substance inventory record is a crucial step to maintain accurate documentation.
D. Returning the unused portion of a controlled substance to the pharmacy is not an appropriate action and goes against medication safety protocols. Controlled substances should be wasted and documented properly.
Correct Answer is A
Explanation
A. Surveying the target population is the best approach to identify the specific interests and
health concerns of the older adults, ensuring that the programs are relevant and tailored to their needs.
B. Determining the availability of health care providers is a logistical consideration but may not necessarily address the specific interests or needs of the older adults.
C. Basing the programs on their developmental stage is important, but surveying the population allows for a more comprehensive understanding of their diverse needs and preferences.
D. Reviewing Healthy People 2020 Objectives is a valuable resource, but it may not capture the specific interests or concerns of the local population.
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