Answer to Question 1
B
The first step in assessing body alignment is to put the client at ease so that unnatural or rigid positions are not assumed.
When assessing body alignment, the nurse's first action is to put the client at ease. Later, the nurse may assess the client's gait to observe the client's balance, posture, and ability to walk without assistance.
Activity tolerance is the kind and amount of exercise or activity a person is able to perform. De-termining activity tolerance is not the first step in assessing a client's body alignment.
Assessing range of motion (ROM) is one of the first assessment techniques used to determine the degree of damage or injury to a joint. It is not the first step in assessing a client's body alignment.
Answer to Question 2
A
The nurse should recognize the importance of privacy and confidentiality and safeguard the cli-ent's personal, family, and community information obtained in the context of a professional rela-tionship.
Fidelity refers to an agreement to keep promises.
Veracity, in general, means accuracy or conformity to truth. In this situation, the nurse encour-ages the client to be truthful with her family.
Justice refers to fairness.
Assessing structures of the mouth.
The effects of undernourishment on the body systems.
Example of simplified note for one-time client.
Testing client’s ability to identify sharp sensations
Testing the Achilles tendon reflex with client in a supine position
Percentage of youth age 15 to 19 years with at-risk levels of body composition & fitness