The nurse assesses the quality of which of the following patient characteristics when applying the Get-Up-and-Go test from the Hendrich II Fall Risk Model?
Balance
Stride
Flexibility
Speed
The Correct Answer is A
A. Balance:
The Get-Up-and-Go test assesses the patient's ability to maintain balance during the process of standing up from a chair, walking a short distance, turning around, and sitting down. Impaired balance can be a significant risk factor for falls.
B. Stride:
Stride, or the length of a person's step, is not explicitly assessed in the Get-Up-and-Go test. However, the test may indirectly provide information about the patient's walking pattern and step characteristics.
C. Flexibility:
While flexibility is not a specific focus of the Get-Up-and-Go test, the test involves movements that require a degree of joint flexibility, such as bending the knees to stand up and sit down.
D. Speed:
Speed is an important aspect of the Get-Up-and-Go test. The time taken by the patient to complete the entire sequence of standing up, walking, turning, and sitting down is considered. Slower performance on the test may indicate an increased risk of falls.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Four-length rails.
Explanation: Four-length rails fully enclose the bed and can be considered a more restrictive measure. They may be used when a restraint order is in place, but for an alert patient without such an order, less restrictive alternatives are preferred.
B. One-length rail.
Explanation: Using one-length rails can be a less restrictive alternative when a patient is at high risk for falling. The use of one side rail allows for some protection against falls without fully restraining the patient. This approach helps maintain the patient's mobility and autonomy while still providing a safety measure.
C. Two full-length rails.
Explanation: While using two full-length rails is less restrictive than four-length rails, it is still more restrictive than using only one side rail. The goal is to balance fall prevention with the patient's autonomy.
D. No side rails.
Explanation: Using no side rails may not provide adequate protection for an alert patient at high risk for falling. While avoiding restraints is essential, implementing at least one side rail is a reasonable compromise to enhance safety without fully restricting the patient's movement.
Correct Answer is ["A","B","C"]
Explanation
Medicare supplemental insurance, commonly known as Medigap, does not have a Part 8. The options provided seem to be a combination of different parts of Medicare and supplementary insurance.
A. It covers the costs of outpatient services.
Explanation: This statement is generally true, but it is associated with Medicare Part B, which covers outpatient services. Medigap plans can help cover some of the out-of-pocket costs associated with Medicare Part B services.
B. It must be purchased and is a subsidized medical policy.
Explanation: This statement is partially true. Medigap policies must be purchased, but they are not subsidized. Individuals pay private insurance companies for Medigap coverage to help pay for certain costs not covered by Original Medicare (Parts A and B).
C. It covers the costs of speech therapy.
Explanation: This statement is generally true. Medigap plans may cover part or all of the costs associated with Medicare-approved services, including speech therapy.
D. It covers medication costs.
Explanation: This statement is not entirely accurate. Medigap plans do not cover prescription drugs. Coverage for prescription medications is typically provided through Medicare Part D, which is a separate prescription drug coverage plan.
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