Because the older adult's blood vessels are nonelastic, they are prone to orthostatic hypotension. A priority intervention for a patient with orthostatic hypotension is to:

allow the patient to sit on the side of the bed for a minute before standing.

instruct the patient to use the wheelchair for all mobility activity.

keep the patient in bed in a high Fowler's position

help the patient to rise quickly and support the patient for a minute.

Answer and Explanation

The Correct Answer is A

A.   Allowing the patient to sit on the side of the bed helps to prevent sudden drops in blood pressure and allows the body to adjust to the change in position, reducing the risk of fainting or dizziness.
B.   Using a wheelchair for mobility may not address the root cause of orthostatic hypotension and may limit the patient's independence.
C.   Keeping the patient in a high Fowler's position could worsen the symptoms of orthostatic hypotension.
D.   Rising quickly could lead to a sudden drop in blood pressure and increase the risk of a fall or injury.

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Correct Answer is A

Explanation

A. Pushing the soles of the feet against the nurse's hands is a standard test to assess the strength of the lower extremities. It provides a clear indication of muscular strength and motor function.
B. Wiggling toes helps assess for sensation but does not evaluate overall strength or motor function in the lower extremities.
C. Pulling both feet up to stretch the Achilles tendons is not an appropriate method for assessing lower extremity strength.
D. Standing independently does not evaluate strength comprehensively and is more related to balance and coordination.

A. the eyes move in a normal coordinated manner. B. the pupils dilate when focusing on the object. C. there is blinking while trying to focus on the object. D. the pupils constrict focusing on the object.

Correct Answer is A

Explanation

A. Checking for normal, coordinated eye movement is key when assessing extraocular movements, which should be smooth and symmetric.
B. Pupillary dilation occurs under specific circumstances, such as low light, not necessarily when focusing on an object.
C. Blinking is a normal reflex but not a primary indicator when assessing extraocular movements.
D. Pupillary constriction is a separate function of the pupillary light reflex and not directly associated with extraocular movements.

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Because the older adult's blood vessels are nonelastic, they are prone to orthostatic hypotension. A priority intervention for a patient with orthostatic hypotension is to:

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