The nurse is teaching a client with debilitating rheumatoid arthritis about home safety. Which statement should the nurse include?
"There are many adaptive devices such as grab bars, reaching tools, grasping devices, and adaptive silverware available that may help you."
"My grandfather always had problems with his arthritis, and he would tell me that it's better to be more stoic and not let pain interrupt your life."
"Place throw rugs throughout your home. You'll enjoy how pretty they are, and you can use them to cover up power cords, so you don't trip on them."
"Lack of home safety may be an issue of compliance. Are you being compliant with your medications?"
The Correct Answer is A
Choice A reason: This statement is correct and should be included in the nurse's teaching. It informs the client about the availability and benefits of adaptive devices that can enhance their home safety and independence. It also shows the nurse's empathy and respect for the client's needs and preferences.
Choice B reason: This statement is incorrect and should not be included in the nurse's teaching. It reflects the nurse's personal opinion and bias, and it may discourage the client from seeking help or expressing their pain. It also shows the nurse's lack of understanding and compassion for the client's condition and challenges.
Choice C reason: This statement is incorrect and should not be included in the nurse's teaching. It suggests an unsafe and hazardous practice that can increase the risk of falls and injuries for the client. It also shows the nurse's negligence and irresponsibility for the client's home safety.
Choice D reason: This statement is incorrect and should not be included in the nurse's teaching. It implies that the client is noncompliant and blames them for their home safety issues. It also shows the nurse's judgmental and accusatory attitude towards the client.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: This is not the best intervention because it is timeconsuming and may not be feasible in some situations. Writing down the message can also be impersonal and may not convey the tone or emotion of the speaker. The nurse should use verbal communication as much as possible and supplement it with nonverbal cues, such as gestures, facial expressions, and eye contact.
Choice B reason: This is an incorrect intervention because it can be annoying and ineffective. Talking loudly in the impaired ear can cause discomfort and distortion of the sound. It can also damage the remaining hearing in the ear. The nurse should not shout or raise their voice, but rather speak at a normal volume and enunciate clearly.
Choice C reason: This is the best intervention because it enhances the quality and clarity of the verbal message. Speaking slowly and clearly while facing the client allows the client to see the nurse's mouth movements and facial expressions, which can help them understand the words and the meaning. The nurse should also avoid covering their mouth or chewing gum while speaking.
Choice D reason: This is not the best intervention because it can be inconvenient and impractical. Talking in a regular voice in the good ear may require the nurse to move around the client or position themselves in a certain way. It can also make the client feel isolated or singled out. The nurse should try to communicate with the client in a way that is comfortable and respectful for both parties.
Correct Answer is D
Explanation
Choice A reason: This is not the priority assessment, but it is an important assessment for a client with a femur fracture. Pain is the unpleasant sensation that results from tissue damage or inflammation. Pain can affect the client's physical and psychological wellbeing and interfere with their recovery. The nurse should assess the client's pain level, location, quality, and duration using a valid and reliable pain scale. The nurse should also provide pain relief measures, such as medication, ice, elevation, or distraction, as ordered and as needed.
Choice B reason: This is not the priority assessment, but it is a relevant assessment for a client with a femur fracture. Medication history is the record of the drugs that the client is currently taking or has taken in the past, including prescription, overthecounter, herbal, or recreational drugs. Medication history can help the nurse identify any potential drug interactions, allergies, or contraindications that may affect the client's treatment and recovery. The nurse should ask the client about their medication history and document it accurately and completely.
Choice C reason: This is not the priority assessment, but it is a helpful assessment for a client with a femur fracture. Socioeconomic status is the measure of the client's income, education, occupation, and social class. Socioeconomic status can influence the client's access to health care, ability to afford treatment, compliance with therapy, and support system. The nurse should assess the client's socioeconomic status and provide appropriate referrals, resources, or assistance as needed.
Choice D reason: This is the priority assessment for a client with a femur fracture. Pedal pulses are the pulses that can be felt in the feet, such as the dorsalis pedis or the posterior tibial pulse. Pedal pulses can indicate the blood flow and perfusion to the lower extremities, which can be compromised by a femur fracture. A femur fracture can cause bleeding, swelling, or pressure that can reduce or obstruct the blood supply to the feet, leading to ischemia, necrosis, or gangrene. The nurse should assess the client's pedal pulses regularly and report any changes, such as absent, weak, or thready pulses. The nurse should also monitor the client's skin color, temperature, sensation, and movement in the feet.
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