It is most important for the nurse to recalculate the Braden scale score for a client who has developed which problem?

Weakened cough effort.

Hypoactive bowel sounds.

Urinary incontinence.

Plus two ankle edema.

Answer and Explanation

The Correct Answer is C

C. Urinary incontinence affects the moisture component of the Braden scale. Proper assessment and interventions are crucial to prevent skin breakdown.

A. A weakened cough effort is not directly related to pressure ulcer risk assessment, which is the purpose of the Braden Scale.

B. Bowel sounds are not included in the Braden Scale assessment criteria.

D. Ankle edema is not included as a factor in the Braden Scale assessment.

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Correct Answer is B

Explanation

B. Allowing a period of rest before feeding is not a standard practice for individuals at risk for aspiration and may not address the underlying issues related to dysphagia or aspiration risk. A, C, D- are appropriate positions during feeding for clients with stroke to prevent choking/aspiration.

A. Living will becomes invalid when receiving hospice care. B. Hospice services can be initiated prior to discharge. C. Family members can be involved in the plan of care. D. Provides comfort, dignity, and emotional support. E. Can be provided within comforts of home.

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

Explanation

B. Hospice services can be initiated while the client is still in the hospital. Hospice teams can work alongside the hospital staff to provide care and support to the client and family during the transition to hospice care.
C. Hospice care emphasizes the involvement of family members in the care of the patient. The hospice team works with the patient and family to develop a personalized plan of care that addresses the physical, emotional, and spiritual needs of the patient and family members.
D. Hospice care focuses on providing comfort, maintaining dignity, and offering emotional support to patients with terminal illnesses and their families. The goal is to enhance quality of life and ensure that the patient's wishes and preferences are respected throughout the end-of- life process.
E. Hospice care can be provided in various settings, including the patient's own home, assisted living facilities, nursing homes, or inpatient hospice units. The option to receive care in the comfort of home is often preferred by many patients and families as it allows them to remain in familiar surroundings surrounded by loved ones.

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It is most important for the nurse to recalculate the Braden scale score for a client who has developed which problem?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse observes an unlicensed assistive personnel (UAP) feeding a client who had a cerebral vascular accident (CVA) and is at risk for aspiration. Which action by the UAP should the nurse recognize indicates the need for additional teaching?

Correct Answer is B

Explanation

A female client with metastatic breast cancer is admitted with shortness of breath and pleural effusions. The client has a living will and the family is requesting hospice information. Which information should the nurse provide regarding hospice? Select all that apply.

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

Explanation

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It is most important for the nurse to recalculate the Braden scale score for a client who has developed which problem?

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