A nurse is providing discharge instructions to a client about proper use of a cane for maximum support. Which of the following statements by the client indicates an understanding of the teaching?
"I will hold my cane on my stronger side."
"I should hold my cane 12 inches from my side."
"I will keep my elbow flexed at a 90-degree angle while moving my cane."
"I should move my weaker leg before moving my cane."
The Correct Answer is A
A. "I will hold my cane on my stronger side." The cane should be held on the stronger (unaffected) side to provide better support and stability while allowing the weaker leg to move more freely.
B. "I should hold my cane 12 inches from my side." The cane should be positioned about 6–10 inches to the side of the foot to ensure proper balance and support.
C. "I will keep my elbow flexed at a 90-degree angle while moving my cane." The elbow should be flexed at about 15–30 degrees, not 90 degrees, to maintain comfort and proper control of the cane.
D. "I should move my weaker leg before moving my cane." The correct sequence is to move the cane first, then move the weaker leg forward, followed by the stronger leg, which provides better stability and reduces fall risk.
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Related Questions
Correct Answer is D
Explanation
A. "I should close all doors and windows on the unit." –
This action is part of the "C" (Confine) step, which should be done before attempting to extinguish the fire.
B. "I should evacuate clients who are in immediate danger." –
Rescuing clients is the first step and should be done immediately.
C. "I should activate the facility's fire alarm system." –
Activating the alarm is the second step after rescuing clients.
D. "I should extinguish small fires if it is safe to do so." –
Extinguishing the fire is the last action in the fire safety protocol and should only be attempted if the fire is small and controllable.
Correct Answer is ["A","B","C","D","E","F","G","H"]
Explanation
The key pieces of information that indicate the client is at risk for falls include:
- Admitted following a fall down approximately five steps – Indicates a recent fall history.
- Client's partner reports client possibly hit their head and was a little disoriented for a minute or two – Suggests potential confusion or altered mental status.
- Client has a history of falls and orthostatic hypotension per client's partner – A significant risk factor for future falls.
- Client uses a walker – Indicates mobility impairment.
- Client ordered new glasses following an eye exam last week but has not received them yet – Vision impairment increases fall risk.
- Blood pressure: Lying: 130/90 mm Hg, Sitting: 128/88 mm Hg, Standing: 98/60 mm Hg – Orthostatic hypotension (drop in BP upon standing) can cause dizziness and falls.
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