Swift River - Health
Assessment/Fundamentals with
Complete Solutions!
Hildegard Lowe
Diagnosis: fractured ulna, macular degeneration, osteoporosis
DOB: 5/22/1956
MRN: 52919120
Room: 103 - ANSWER-Which of the following concerns should the nurse plan to address?
(Select all that apply.)
Physiological: Pain
Physiological: Sensory
Safety: Injury prevention
Physiological: Tissue Integrity
A nurse is observing an AP assisting a client who has visual impairment with their meal.
Which of the following actions by the AP require follow-up by the nurse? (Select all that
apply.)
Feeding the client
Entering client's room without announcing their presence
A nurse is updating the plan of care for a 68-year-old client who has a visual impairment,
osteoporosis, and a casted right arm. Which of the following interprofessional team members
should the nurse recommend the provider consult? (Select all that apply.)
Physical therapy (PT)
Occupational therapy (OT)
Nutritionist
Case manager
A nurse is caring for an older adult client who has a visual impairment, osteoporosis, and a
fractured right arm. Which of the following safety interventions should the nurse implement?
(Select all that apply.)
Orient the client to the environment of their hospital room.
, Physiological: Thermoregulation
Which of the following instructions should the nurse include in the teaching? (Select all that
apply.)
Place the collection container into urine stream after they have started voiding.
Instruct the client to cap the container tightly after collecting the specimen.
The nurse is reviewing the laboratory results for the client. Which of the following findings
indicate that the client is experiencing a urinary tract infection? (Select all that apply.)
Appearance
Color
RBCs
WBCs
Which of the following actions should the nurse plan to take to gather assessment data?
(Select all that apply.)
State, "I will give you a sticker when we are all done with your vital signs."
Divide collecting of measurements into small steps.
Allow the child to decide if you will take the vital signs or do her weight first.
Allow the client to hop around the room during the exam.
Which of the following assessments should the nurse anticipate? (Select all that apply.)
Screening of vision with a letter or picture eye chart
Hearing screen
Lab test for thyroid levels
Lab test to check for lead poisoning
Neurologic check for choreiform movements
Medical and developmental history
Which of the following statement should the nurse include when giving instructions? (Select
all that apply.)
"We are going to check how your ears work. I want to make sure you hear all those doggy
friends of yours."
"Can you point to where your ears are located?"
"First, we are going to put on these headphones on your ears."
Assessment/Fundamentals with
Complete Solutions!
Hildegard Lowe
Diagnosis: fractured ulna, macular degeneration, osteoporosis
DOB: 5/22/1956
MRN: 52919120
Room: 103 - ANSWER-Which of the following concerns should the nurse plan to address?
(Select all that apply.)
Physiological: Pain
Physiological: Sensory
Safety: Injury prevention
Physiological: Tissue Integrity
A nurse is observing an AP assisting a client who has visual impairment with their meal.
Which of the following actions by the AP require follow-up by the nurse? (Select all that
apply.)
Feeding the client
Entering client's room without announcing their presence
A nurse is updating the plan of care for a 68-year-old client who has a visual impairment,
osteoporosis, and a casted right arm. Which of the following interprofessional team members
should the nurse recommend the provider consult? (Select all that apply.)
Physical therapy (PT)
Occupational therapy (OT)
Nutritionist
Case manager
A nurse is caring for an older adult client who has a visual impairment, osteoporosis, and a
fractured right arm. Which of the following safety interventions should the nurse implement?
(Select all that apply.)
Orient the client to the environment of their hospital room.
, Physiological: Thermoregulation
Which of the following instructions should the nurse include in the teaching? (Select all that
apply.)
Place the collection container into urine stream after they have started voiding.
Instruct the client to cap the container tightly after collecting the specimen.
The nurse is reviewing the laboratory results for the client. Which of the following findings
indicate that the client is experiencing a urinary tract infection? (Select all that apply.)
Appearance
Color
RBCs
WBCs
Which of the following actions should the nurse plan to take to gather assessment data?
(Select all that apply.)
State, "I will give you a sticker when we are all done with your vital signs."
Divide collecting of measurements into small steps.
Allow the child to decide if you will take the vital signs or do her weight first.
Allow the client to hop around the room during the exam.
Which of the following assessments should the nurse anticipate? (Select all that apply.)
Screening of vision with a letter or picture eye chart
Hearing screen
Lab test for thyroid levels
Lab test to check for lead poisoning
Neurologic check for choreiform movements
Medical and developmental history
Which of the following statement should the nurse include when giving instructions? (Select
all that apply.)
"We are going to check how your ears work. I want to make sure you hear all those doggy
friends of yours."
"Can you point to where your ears are located?"
"First, we are going to put on these headphones on your ears."
