Which of the following factors should a nurse consider when assessing a patient's risk for developing pressure ulcers?

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Question 1 of 5

Which of the following factors should a nurse consider when assessing a patient's risk for developing pressure ulcers?

Correct Answer: A

Rationale: The correct answer is A: Patient's age and mobility. Age and mobility are key factors in pressure ulcer development as elderly and immobile patients are at higher risk due to decreased circulation and pressure on skin. Family medical history (B) is not directly linked to pressure ulcers. Frequency of hospital visits (C) is not a determining factor, and patient's education level (D) does not directly impact pressure ulcer risk. In summary, assessing age and mobility helps identify high-risk patients for developing pressure ulcers.

Question 2 of 5

A 17-year-old single mother is describing how difficult it is to raise a 2-year-old by herself. During the course of the interview, she states, "I can't believe my boyfriend left me to do this by myself! What a terrible thing to do to me!" Which of the following responses by the nurse uses empathy?

Correct Answer: C

Rationale: The correct answer is C because it reflects empathy by acknowledging the mother's feelings without judgment or personal bias. The nurse shows understanding and compassion by recognizing the difficulty of the situation. Incorrect answer A lacks empathy as it simply restates the mother's feeling without demonstrating understanding. Answer B also lacks empathy as it focuses on the boyfriend's actions rather than the mother's feelings. Answer D shows some empathy by acknowledging the difficulty but fails to address the mother's emotional state directly. In summary, answer C is correct because it shows empathy by acknowledging the mother's emotions and validating her experience without judgment or redirection.

Question 3 of 5

During an interview, the nurse notices that the patient is avoiding eye contact. What would be the best action for the nurse to take?

Correct Answer: C

Rationale: The correct answer is C because asking open-ended questions helps the patient express their feelings without feeling pressured. This approach allows the patient to share at their own pace and comfort level. Choice A may make the patient feel uncomfortable or pressured. Choice B may not address the underlying issue of the patient's avoidance of eye contact. Choice D is more direct and may not be effective if the patient is not ready to discuss their emotions. Ultimately, using open-ended questions promotes a safe and supportive environment for the patient to open up willingly.

Question 4 of 5

A nurse is interviewing a 75-year-old patient. Why might the interview take longer with this patient?

Correct Answer: A

Rationale: The correct answer is A. Older adults may have a longer story to tell due to their wealth of life experiences. This can include medical history, family background, and personal stories that may impact their health. It is important for the nurse to gather all relevant information to provide appropriate care. Choice B is incorrect because not all older adults are lonely, and the reason for a longer interview is not solely based on the need for social interaction. Choice C is incorrect because while some older adults may experience cognitive decline, it is not a blanket statement that all older adults lose mental abilities. Choice D is incorrect because hearing loss is not a universal issue among older adults, and assuming so can lead to ageist stereotypes.

Question 5 of 5

Which technique is most effective for assessing the patient's abdominal organ size?

Correct Answer: B

Rationale: The correct answer is B: Palpation. Palpation is the most effective technique for assessing the patient's abdominal organ size as it allows the healthcare provider to feel and evaluate the size, texture, and consistency of the abdominal organs through touch. This hands-on approach provides valuable information about any abnormalities or tenderness in the organs. Inspection (choice A) involves looking at the abdomen for any visible signs but does not provide information on organ size. Percussion (choice C) involves tapping on the abdomen to assess the density of underlying structures, not specifically organ size. Auscultation (choice D) involves listening to sounds within the abdomen and does not directly assess organ size. Palpation is the preferred method for accurately assessing abdominal organ size due to its tactile nature.

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