The nurse is conducting a psychosocial assessment. Which of the following would be included in this assessment? (Select all that apply)
CAGE assessment
Heinrich Fall Scale
Mini-Mental Status Exam
Activities of Daily Living Tool
Correct Answer : C,D
The Mini-Mental Status Exam assesses cognitive function, which is often included in the psychosocial assessment, and the Activities of Daily Living Tool assesses the patient's ability to perform daily tasks, which is also important to understand the patient's level of functioning.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A"]
Explanation
To map the client's abdomen into four quadrants, the nurse should use the umbilicus as the landmark to perform this assessment. The abdomen is divided into four quadrants by drawing an imaginary line from the center of the umbilicus to the pubic symphysis and another line from the center of the umbilicus to the xiphoid process of the sternum. This helps in identifying the location of any potential abdominal discomfort or tenderness.
Correct Answer is B
Explanation
Pain is a subjective experience, and the client's report of pain should be respected and addressed promptly. If the pain medication is ordered and it has been longer than the ordered interval, the nurse should administer the medication as prescribed. In general, withholding pain medication for a client in pain is not an appropriate action.
Administering half the ordered dose of pain medication without a healthcare provider's order is also not appropriate. The nurse should follow the healthcare provider's orders for pain medication administration and titration.
It's also not appropriate to assume that the client is faking pain without adequate assessment and evidence to support such a claim. The nurse should perform a thorough pain assessment, including the location, intensity, and quality of the pain, and consider non-pharmacological interventions to help manage the pain.
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