A nurse is assessing an older client’s risk for falls. Which of the following assessments should the nurse use to identify the client’s safety needs? (Select ONE that does not apply)

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Acute Respiratory Care Nursing Questions Questions

Question 1 of 5

A nurse is assessing an older client’s risk for falls. Which of the following assessments should the nurse use to identify the client’s safety needs? (Select ONE that does not apply)

Correct Answer: A

Rationale: Pupil clarity, Visual fields, Visual acuity.

Question 2 of 5

When moving a client up in bed with the assistance of another caregiver, the nurse should:

Correct Answer: D

Rationale: A pillow provides comfort and support. Elevating (A) hinders movement. Folding arms (B) isn’t standard. Asking another nurse (C) is unclear.

Question 3 of 5

A nurse is caring for a patient who was in a motor vehicle accident that resulted in cervical trauma to C Which assessment is the priority?

Correct Answer: B

Rationale: C4 trauma can impair the phrenic nerve, which innervates the diaphragm. Respiratory failure is a life-threatening risk, making respiration the priority assessment over pain, temperature, or blood pressure.

Question 4 of 5

A patient with chronic obstructive pulmonary disease (COPD) is at risk for which complication?

Correct Answer: A

Rationale: COPD impairs gas exchange, leading to hypoxemia (low blood oxygen) due to airway obstruction and alveolar damage, not hyperoxia, bradycardia, or hypertension.

Question 5 of 5

A patient with heart failure is at risk for which oxygenation issue?

Correct Answer: A

Rationale: Heart failure can cause pulmonary edema (fluid in alveoli), impairing gas exchange and oxygenation, more than pneumothorax, bronchitis, or hyperventilation.

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