1. 1. Question
A patient with Parkinson’s disease has a nursing diagnosis of Impaired Physical Mobility related to neuromuscular impairment. You
... [Show More] observe a nursing assistant performing all of these actions. For which action must you intervene?
o A. The NA assists the patient to ambulate to the bathroom and back to bed.
o B. The NA reminds the patient not to look at his feet when he is walking.
o C. The NA performs the patient’s complete bath and oral care.
o D. The NA sets up the patient’s tray and encourages the patient to feed himself.
Correct Answer: C. The NA performs the patient’s complete bath and oral care.
The nursing assistant should assist the patient with morning care as needed, but the goal is to keep this patient as independent and mobile as possible.
o Option A: Assisting the patient to ambulate prevents incidences of fall and injury.
o Option B: Reminding the patient not to look at his feet while walking maintains the client’s independence while keeping him safe.
o Option D: Encouraging the patient to feed himself is an appropriate goal of maintaining independence.
2. 2. Question
The nurse is preparing to discharge a patient with chronic low back pain. Which statement by the patient indicates that additional teaching is necessary?
o A. “I will avoid exercise because the pain gets worse.”
o B. “I will use heat or ice to help control the pain.”
o C. “I will not wear high-heeled shoes at home or work.”
o D. “I will purchase a firm mattress to replace my old one.”
Correct Answer: A. “I will avoid exercise because the pain gets worse.”
Exercises are used to strengthen the back, relieve pressure on compressed nerves and protect the back from re-injury. Doing exercises to strengthen the lower back can help alleviate and prevent lower back pain. It can also strengthen the core, leg, and arm muscles. According to researchers, exercise also increases blood flow to the lower back area, which may reduce stiffness and speed up the healing process.
o Option B: Ice and heat application are appropriate interventions for back pain. Applying ice or a reusable gel pack constricts blood vessels and reduces swelling around the injury. This is particularly useful for conditions, like a sprained ankle, that cause significant swelling. Heat has the opposite effect, increasing blood flow to the area. This relaxes muscle fibers, which can help when the client experiences spasms or stiffness.
o Option C: People with chronic back pain should avoid wearing high-heeled shoes at all times. The normal s-curve of the spine acts as a cushion or spring, reducing stress on the vertebrae. When wearing high heels, the shape of the spine is altered and the client doesn’t get that same shock absorption as she walks, which, over time, can lead to uneven wear on the cartilage discs, joints and ligaments of the back.
o Option D: A firm mattress prevents lower back pain. Sleeping on a mattress that is too firm can cause aches and pains on pressure points. A medium-firm mattress may be more comfortable because it allows the shoulder and hips to sink in slightly. Patients who want a firmer mattress for back support can get one with thicker padding for greater comfort. [Show Less]