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Exam NCLEX-PN topic 6 question 50 discussion

Actual exam question from Test Prep's NCLEX-PN
Question #: 50
Topic #: 6
[All NCLEX-PN Questions]

The home health nurse has made a visit to an 85-year-old female clients home who has recently had surgery to replace her left knee. The client has been discharged from a rehab facility and has been able to walk on her own. The nurse assesses the need for teaching related to fall prevention. What should the nurse include in this teaching plan?

  • A. The client should remove all scatter rugs from the floor and minimize clutter.
  • B. The client should not get up and move around the house.
  • C. The client does not need to install a raised toilet and grab bar because she is able to walk on her own.
  • D. The client should wear a robe and socks while walking in the house.
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Suggested Answer: A 🗳️
Rugs and clutter are a primary cause of falls in the home and should be eliminated if possible to decrease the risk of a fall. The elderly and those with gait issues are at an increased risk for a fall at home. The client should have a raised toilet seat and grab bars available in the bathroom to aid in movement in this potential slippery area of the home. Some clients find it difficult to rise up and down from the toilet and to get in and out of the shower. These items are all important in maintaining safety in the home. The client should not limit her movement within the home unless ordered by the physician. This decreases the ability of the client to perform activities of daily living and hinders the clients return to a normal lifestyle after surgery. The client should not wear baggy clothing such as long robes, and the client should not wear socks on slippery floors. These items can cause the client to trip, slip, or fall. Health Promotion and Maintenance
by [deleted] at March 10, 2025, 5:51 a.m.

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