An older adult female client is hospitalized with a fractured femur. During a routine nursing assessment, she repeatedly asks the nurse to “speak up” so that she can hear the questions. Which action is best for the nurse to take?

Raise voice volume to a shout

Over-enunciate word syllables

Decrease speaking speed

Exaggerate nonverbal expressions

Answer and Explanation

The Correct Answer is C

Choice A reason: Shouting increases volume but may distort speech, worsening comprehension for an older adult with hearing loss. Age-related presbycusis impairs high-frequency sound perception, and shouting can cause discomfort without improving clarity, making this an ineffective communication strategy for the client.

Choice B reason: Over-enunciating syllables may help slightly but can sound unnatural, confusing the client. It does not address the primary issue of processing speed in age-related hearing loss, where slower speech allows better auditory processing, making this less effective than reducing speaking speed.

Choice C reason: Decreasing speaking speed is best, as presbycusis slows auditory processing in older adults. Slower speech allows the client to process sounds clearly, improving comprehension without distortion, addressing the client’s difficulty hearing questions effectively and enhancing communication during the assessment.

Choice D reason: Exaggerating nonverbal expressions aids visual cues but does not address auditory comprehension. Hearing loss requires auditory adjustments, and nonverbal cues alone are insufficient for understanding spoken questions, making this less effective than slowing speech to improve verbal clarity.

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Correct Answer is C

Explanation

Choice A reason: Unexplained weight loss is not directly relevant to pyridostigmine administration. Myasthenia gravis affects neuromuscular junctions, and pyridostigmine enhances acetylcholine, improving muscle strength. Weight loss may indicate systemic issues, but it does not affect the drug’s immediate safety or efficacy, making this choice secondary.

Choice B reason: Trouble sleeping is unrelated to pyridostigmine’s administration. The drug targets acetylcholinesterase, increasing muscle strength in myasthenia gravis, but does not typically affect sleep. Insomnia may reflect other conditions, but it is not a critical pre-administration concern compared to cholinergic side effects.

Choice C reason: Difficulty with urination is critical, as pyridostigmine’s cholinergic effects can exacerbate urinary retention by stimulating bladder smooth muscle. In myasthenia gravis, this may worsen existing autonomic dysfunction, risking complications like infection, making this the most important information to assess before administration.

Choice D reason: Recent oral intake is relevant for gastrointestinal side effects, as pyridostigmine may cause nausea, but it is less critical than urinary issues. Taking the drug with food can mitigate nausea, but urinary retention poses a greater immediate risk, making this choice secondary.

A. Hemoglobin B. Serum creatinine C. Blood glucose D. Liver enzymes

Correct Answer is A

Explanation

Choice A reason: Hemoglobin is critical to review, as diclofenac, an NSAID, can cause gastrointestinal bleeding, leading to anemia. Pale appearance and fatigue suggest blood loss, reducing oxygen-carrying capacity. Low hemoglobin confirms anemia, necessitating intervention to prevent further complications, making this the priority laboratory value.

Choice B reason: Serum creatinine monitors renal function, as diclofenac may cause nephrotoxicity, but pale appearance and fatigue point to anemia from bleeding, not renal issues. Renal effects are less immediate than blood loss, making hemoglobin more urgent to assess in this context.

Choice C reason: Blood glucose is irrelevant, as diclofenac does not significantly affect glucose metabolism. Pale appearance and fatigue are classic anemia symptoms, not hypoglycemia, making hemoglobin the priority over glucose, which does not explain the client’s presentation in rheumatoid arthritis.

Choice D reason: Liver enzymes monitor hepatotoxicity, a diclofenac side effect, but pale appearance and fatigue suggest anemia from gastrointestinal bleeding, not liver dysfunction. Hemoglobin directly addresses the likely cause, making it more critical than liver enzymes for immediate evaluation.

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An older adult female client is hospitalized with a fractured femur. During a routine nursing assessment, she repeatedly asks the nurse to “speak up” so that she can hear the questions. Which action is best for the nurse to take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with myasthenia gravis receives a new prescription for pyridostigmine. Which information should the nurse obtain prior to administering the medication?

Correct Answer is C

Explanation

The nurse is caring for a client who is taking diclofenac for rheumatoid arthritis. During a clinic visit, the client appears pale and reports increasing fatigue. Which of the client’s serum laboratory values is most important for the nurse to review?

Correct Answer is A

Explanation

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An older adult female client is hospitalized with a fractured femur. During a routine nursing assessment, she repeatedly asks the nurse to “speak up” so that she can hear the questions. Which action is best for the nurse to take?

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