A nurse who is off duty finds a woman who has collapsed and has right-sided weakness and slurred speech. Which of the following actions should the nurse take?

Drive the client to the nearest emergency department.

Obtain the telephone number of the client's provider.

Find a location for the client to sit.

Call emergency services.

Answer and Explanation

The Correct Answer is D

A. Driving the client to the emergency department is not appropriate when the client is experiencing symptoms of a potential stroke; immediate medical assessment is needed.
B. Obtaining the telephone number of the client's provider does not address the immediate need for emergency medical care.
C. Finding a location for the client to sit does not address the urgency of the situation; prompt medical attention is crucial.
D. Calling emergency services is the correct action to ensure the woman receives timely medical care for stroke symptoms.

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Correct Answer is D

Explanation

A. Standing in a tripod position prior to walking with crutches is a correct stance to maintain balance and stability.
B. Keeping the elbows flexed helps absorb shock during ambulation and is appropriate when using crutches.
C. Pushing downward on the handgrips is necessary to generate upward force and support while using crutches.
D. Placing partial weight on the affected leg while ambulating with crutches using a three-point gait is incorrect and can jeopardize safety by potentially causing injury or instability.

A. (Select all that apply.) B. Low back pain C. Urine color D. Blood pressure E. Respiratory rate

Correct Answer is ["C","D"]

Explanation

A. While low back pain can be concerning, it's not an immediate priority compared to the vital sign changes. However, the nurse should document the pain and ask about its characteristics.
B. Brown-colored urine can sometimes indicate dehydration or certain medical conditions, requiring follow-up.
C. A significant drop in blood pressure (74/50 mmHg) indicates hypotension and requires immediate attention.
D. An increase in respiratory rate (28 breaths/min) suggests the client may be experiencing respiratory distress and needs evaluation.
E. The client’s oxygen saturation is 95% on room air which is normal.

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A nurse who is off duty finds a woman who has collapsed and has right-sided weakness and slurred speech. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing a client's ability to ambulate with crutches using a three-point gait. Which of the following actions should the nurse identify as a risk to the client's safety?

Correct Answer is D

Explanation

36. A nurse is caring for a client. Exhibits Which of the following findings at 1015 requires further action?

Correct Answer is ["C","D"]

Explanation

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