what are the key factors in assessing a patients fall risk
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Nursing Elites

ATI LPN

ATI PN Comprehensive Predictor

1. What are the key factors in assessing a patient's fall risk?

Correct answer: A

Rationale: The correct answer is A. Assessing the patient's age and mobility are key factors in determining fall risk. Age can affect balance and reaction time, while mobility influences the patient's stability. Choices B, C, and D are important considerations in assessing a patient's fall risk as well, but age and mobility play a more direct role in determining the patient's susceptibility to falls.

2. How should a healthcare professional care for a patient with a colostomy?

Correct answer: A

Rationale: Emptying the colostomy bag regularly is essential to prevent leakage and infection. By regularly emptying the bag, the risk of irritation to the skin surrounding the stoma is reduced. Providing a high-fiber diet is important for overall bowel health but is not directly related to colostomy care. While monitoring for signs of infection is crucial, the primary focus should be on proper bag emptying. Changing the colostomy bag every 3 days may not be necessary for all patients and could vary based on individual needs and the type of colostomy.

3. A charge nurse on a long-term care unit is preparing to delegate tasks to a licensed practical nurse (LPN) and an assistive personnel (AP). Which of the following tasks should the charge nurse delegate to the LPN?

Correct answer: B

Rationale: The correct task to delegate to the LPN is administering initial NG tube feeding. LPNs are trained to carry out this task as it falls within their scope of practice. Inserting an IV catheter (Choice A) is typically performed by registered nurses. Administering insulin (Choice C) and giving medications for diabetes (Choice D) involve assessing the patient's condition and adjusting medication dosage, which are responsibilities of registered nurses or higher-level healthcare providers.

4. A nurse is assisting with an in-service about hepatitis A for a group of staff nurses. The nurse should include that hepatitis A is transmitted through which of the following methods?

Correct answer: D

Rationale: The correct answer is D: Consumption of contaminated food. Hepatitis A is primarily transmitted through the ingestion of contaminated food or water. Airborne droplets and sexual contact are not common modes of transmission for hepatitis A. While contact with contaminated surfaces can play a role in the spread of some infections, hepatitis A is not typically transmitted through this route.

5. What is the most appropriate response when a client with chronic kidney disease asks about fluid restrictions?

Correct answer: B

Rationale: The most appropriate response when a client with chronic kidney disease asks about fluid restrictions is to inform them that limiting fluid intake may be necessary to prevent fluid overload. This is crucial in managing the condition and preventing complications such as edema and electrolyte imbalances. Choice A is incorrect as fluid restrictions are commonly advised for clients with chronic kidney disease. Choice C is partially correct as fluid restrictions are indeed based on lab results and daily weights, but the primary goal is to prevent fluid overload. Choice D is incorrect because fluid restrictions are not limited to just during dialysis; they are often recommended throughout the day to manage the condition.

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