A nurse is preparing to perform an anthropometric assessment on a client. Which of the following client data should the nurse include?

Respiratory rate

Weight

Current pain level

Level of orientation

Answer and Explanation

The Correct Answer is B

A. Respiratory rate:

Respiratory rate is not part of an anthropometric assessment. Anthropometry primarily focuses on physical measurements related to body size, composition, and proportions.

B. Weight:

Anthropometric assessment involves the measurement of various body dimensions, and weight is a

changes over time, and contribute to the overall understanding of a client's health and well-being.

C. Current pain level:

Pain level is not typically included in an anthropometric assessment. Anthropometry is more concerned with physical measurements and does not directly assess subjective experiences like pain.

D. Level of orientation:

Level of orientation is not a component of an anthropometric assessment. Anthropometry is concerned with objective physical measurements and does not assess cognitive or perceptual factors.

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Correct Answer is A

Explanation

A. Endotracheal suctioning:

This is the correct answer. If a client requires endotracheal suctioning, it is likely due to respiratory distress or compromised airway clearance. Ensuring a patent airway and maintaining adequate oxygenation is the top priority, making endotracheal suctioning the first procedure to be performed.

B. Urinary catheter care:

Urinary catheter care is important for preventing infections and maintaining urinary function, but it is generally not as urgent as addressing respiratory distress. If the client is experiencing respiratory issues, addressing these concerns should take precedence.

C. Enteral feeding:

While enteral feeding is essential for providing nutrition, it is not typically as urgent as addressing respiratory needs. If a client requires endotracheal suctioning for respiratory support, it should be prioritized over enteral feeding.

D. Wound irrigation:

Wound irrigation is important for wound care, but it is generally not as time-sensitive as addressing respiratory needs. If the client's airway is compromised, it takes precedence over wound irrigation.

A. The hot water heater is set to 47° C (117° F). B. Grab bars are installed in the shower. C. There is an area rug covering a tile floor. D. Prescriptions are stored in a medication organizer.

Correct Answer is C

Explanation

A. The hot water heater is set to 47° C (117° F).This temperature is within a safe range to prevent burns while ensuring adequate hot water for hygiene.

B. Grab bars are installed in the shower.Grab bars provide support and help prevent falls in older adults, especially those with osteoporosis who are at higher risk for fractures.

C. There is an area rug covering a tile floor.Area rugs are a significant tripping hazard, especially for older adults with osteoporosis, as a fall could lead to fractures. The nurse should intervene to recommend removing or securing the rug to reduce the risk of falls.

D. Prescriptions are stored in a medication organizer.A medication organizer helps older adults manage their medications effectively and reduces the risk of missed or incorrect doses.

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A nurse is preparing to perform an anthropometric assessment on a client. Which of the following client data should the nurse include?

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