EAQ # 3

which instruction provides a client the best description of how to use a prescribed, stationary (non rolling) walker? a) place the walker's back leg tips about an arm's length ahead of the feet, shift the body weight to the walker and step forward. b) move the walker about an arm's length ahead while stepping forward and transferring body weight to all walker leg tips. c) put the walker's front leg tips about an arms length ahead of the feet, shift the body weight to the walker, and step forward. d) position the walker's front leg tips onto the floor about an arms length ahead of the feet and step forward until all tips touch the floor.

c) put the walker's front leg tips about an arms length ahead of the feet, shift the body weight to the walker, and step forward.

The nurse is teaching an adolescent with a sprained ankle how to use one crutch when walking. Which statement indicates that no further teaching is necessary? a) " I shouldn't use my crutch on stairs." b) "After a month I can stop using the crutch." c) " I should place the crutch in front of my bad ankle." d) " I should use the crutch on the side of the good ankle."

d) " I should use the crutch on the side of the good ankle."

which intervention would the nurse classify as the HIGHEST PRIORITY for an older client with lower-extremity ulcerations due to chronic venous insufficiency? a) teaching techniques for dressing changes b) informing the client about insurance companies c) discussing community resources to obtain support d) teaching how to transfer from a bed to chair in the least painful manner

d) teaching how to transfer from a bed to chair in the least painful manner

which interventions would the nurse manager include in a fall prevention program to decrease the number of falls on the unit? Select all that apply. One, some, or all responses may be correct. a) apply fall wristband b) install bed safety alarms. c) establish a toileting schedule. d) allow client to ambulate to bathroom. e) use restraints to prevent the client from leaving the bed.

a) apply fall wristband b) install bed safety alarms. c) establish a toileting schedule.

which action would the nurse take when using a mechanical lift device to transfer a client? a) fold the client's arms across the chest. b) place the top of the sling below the client's scapulae. c) wait until a prescription is written to use a mechanical lift. d) lift the sling at least 12 inches (30.5 cm) above the mattress

a) fold the client's arms across the chest.

which instructions would the nurse give to an older adult with decreased perception of touch? Select all that apply. One, some, or all responses may be correct. a) 'Use a cane for support when walking.' b) 'Hold on to handrails while ambulating.' c) 'Look where your feet are placed while walking.' d) 'Wear shoes that give good support while walking.' e) 'If you are unable to change your position frequently, request assistance.'

b) 'Hold on to handrails while ambulating.' c) 'Look where your feet are placed while walking.' d) 'Wear shoes that give good support while walking.' e) 'If you are unable to change your position frequently, request assistance.'

which nursing intervention is appropriate to include in the plan of care when the nurse is transferring a client with a diagnosis of pheochromocytoma from the bed to a chair? a) supporting the client on the weak side b) ensuring that the chair is close to the client's bed c) placing sturdy shoes with rubber soles on the client's feet d) having the client sit on the side of the bed for a few minutes before the transfer

d) having the client sit on the side of the bed for a few minutes before the transfer

which clinical finding demonstrates to the nurse that the client can use a standard walker? a) weak upper arm strength and impaired stamina b) weight bearing as tolerated and unilateral paralysis c) partial weight bearing on the affected extremity and kyphosis d) strong upper arm strength and non-weight bearing on the affected extremity

d) strong upper arm strength and non-weight bearing on the affected extremity

which action by an adolescent after the use teaches crutch-walking indicates the need for more teaching? a) takes short steps of equal length b) looks forward to maintain balance c) looks down when placing the crutches d) assumes an erect posture when walking

c) looks down when placing the crutches

a client who has a right total hip replacement is progressing from the use of a walker to the use of a cane. In which hand would the nurse teach the client to hold the cane? a) left hand b) right hand c) stronger hand d) dominant hand

a) left hand

which rationale would the nurse use to explain the cane's purpose to a client with hemiparesis who voices a reluctance to use a cane? a) maintain balance to improve stability b) relieve pressure on weight-bearing joints c) prevent further injury to weakened muscles d) aid in controlling involuntary muscle movements

a) maintain balance to improve stability

which intervention would the nurse follow to prevent future falls in an older adult experiencing delirium who sustained a leg fracture caused by a fall? Select all that apply. One, some, or all responses may be correct. a) minimizing sedating medications b) modifying the home environment c) teaching clients about the safe use of the internet d) manage foot and footwear problems e) providing information about the effects of using alcohol

a) minimizing sedating medications b) modifying the home environment d) manage foot and footwear problems

which instructions to minimize the risk of falls in the home would the nurse provide the caregiver of an older client who requires the use of a walker with wheels? Select all that apply. One, some, or all response may be correct. a) remove cords. b) apply bed alarms. c) use bright lighting. d) get rid of throw rugs. e) keep phone close by.

a) remove cords. c) use bright lighting. d) get rid of throw rugs.

the nurse is preparing to teach a 7-year-old child about crutch-walking. Which would be included in the plan? a) demonstrating a four-point gait b) exploring the child's fear of falling c) explaining the reason for the rubber tips on the crutch ends d) discovering how much the child knows about using crutches

b) exploring the child's fear of falling

a client with left-sided weakness is learning how to use a cane. The nurse would demonstrate proper use of the cane by holding it where? a) on alternating sides b) on the right side c) on the side with weakness d) on the side of the client's choice

b) on the right side

which term would the nurse use to document observing the characteristic gait associated with Parkinson disease? a) ataxic b) shuffling c) scissoring d) asymmetric

b) shuffling

which condition would the nurse ensure when adjusting the crutches of an adolescent who sustained an ankle injury while playing soccer and is prescribed crutches and no weight-bearing by the primary health care provider? a) that they reach to 1 inch (2.5 cm) below the axillae b) that they extend to 6 inches (15.2 cm) from the side of each foot c) that the elbows are extended when the crutches are held by the crossbars d) that the shoulders are slightly stooped when the crutches are bearing body weight

b) that they extend to 6 inches (15.2 cm) from the side of each foot

which physiological change occurs in older adults and warrants the nurse teaching the client about safety tips to prevent falls? a) slowed movement b) cartilage degeneration c) decrease bone density d) decreased range of motion (ROM)

c) decrease bone density

the nurse Is planning to teach the four-point alternate crutch gait to a 9-year-old child with cerebral palsy. How would the nurse explain this choice to the parent? a) the child has minimal step ability in the lower extremities. b) it provides for two points of support on the floor at all times. c) it provides for equal but partial weight bearing on each limb. d) the child has more power in the upper extremities than in the lower extremities

c) it provides for equal but partial weight bearing on each limb.

the nurse has provided discharge instructions to a client who received a prescription for a walker. The nurse determines that the teaching has been effective when the client does which? a) picks up the walker and carries it for short distances b) uses the walker only when someone else is present c) moves the walker no more than 2 feet during use d) states that a walker will be purchased on the way home from the hospital

c) moves the walker no more than 2 feet during use