A nurse is planning care for a client who has left-sided hemiplegia. Which of the following actions should the nurse include in the plan?

Initiate frequent, short periods of exercise throughout the day.

Decrease the amount of range of motion performed if tightness occurs.

Perform range-of-motion exercises to the affected side once per day.

Avoid repetitive movements during exercise.

Answer and Explanation

The Correct Answer is A

A) Initiate frequent, short periods of exercise throughout the day: Frequent, short periods of exercise are beneficial for a client with left-sided hemiplegia. Regular movement helps maintain joint flexibility, muscle strength, and overall functional ability. This approach can prevent complications such as contractures and muscle atrophy.

B) Decrease the amount of range of motion performed if tightness occurs: If tightness occurs, rather than decreasing range of motion, it is important to address it through appropriate stretching and adjustments in exercise technique. Reducing range of motion could lead to further loss of mobility and function.

C) Perform range-of-motion exercises to the affected side once per day: Performing range-of-motion exercises only once per day is generally insufficient. To maintain or improve mobility and prevent contractures, range-of-motion exercises should be performed multiple times throughout the day, as directed by the care plan.

D) Avoid repetitive movements during exercise: Repetitive movements are not necessarily harmful and can be beneficial for improving motor function and muscle coordination. However, it is important to balance repetitive exercises with variety and adjust based on the client’s condition and tolerance.

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Correct Answer is C

Explanation

A) Decreased systolic blood pressure: In older adults, systolic blood pressure often increases due to stiffening of the arteries rather than decreasing. This increase in systolic blood pressure is due to reduced elasticity in blood vessels, making it a common physiological change.

B) Decreased anteroposterior chest diameter: In fact, the anteroposterior chest diameter often increases with age due to changes in the rib cage and spine, such as kyphosis. An increased chest diameter is observed in older adults, not a decrease.

C) Increased cerumen thickness: As people age, cerumen (earwax) production can increase and the cerumen can become thicker and drier. This is due to changes in the ceruminous glands and can lead to more frequent earwax impaction in older adults, making it a relevant point to include in the educational program.

D) Increased saliva production: Typically, older adults experience a decrease in saliva production, not an increase. Reduced saliva production can contribute to difficulties with chewing, swallowing, and oral health.

A. "A parent is supposed to pass before their child." B. "My partner and I have plans to open a small business." C. "I have put all the pictures of my child in the attic." D. "My partner says I seem to forget things frequently."

Correct Answer is B

Explanation

A) "A parent is supposed to pass before their child": This statement reflects ongoing grief and a struggle with the loss, indicating the client is still grappling with the emotional impact rather than moving toward reorganization and acceptance.

B) "My partner and I have plans to open a small business": This statement demonstrates that the client is beginning to focus on future goals and engaging in activities that signify a return to normalcy and investment in life. This reflects reorganization and acceptance of the loss as they are planning for the future.

C) "I have put all the pictures of my child in the attic": Putting away pictures of the child might indicate avoidance or difficulty coping with reminders of the loss. This action suggests the client may still be in the process of dealing with grief rather than having reached acceptance.

D) "My partner says I seem to forget things frequently": Frequent forgetfulness can be a symptom of ongoing grief and emotional distress. This indicates that the client may still be experiencing significant emotional and cognitive impacts from the loss.

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A nurse is planning care for a client who has left-sided hemiplegia. Which of the following actions should the nurse include in the plan?

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