NURS 330 Ch. 38 fully solved &
updated 2025-2026(100%
verified for accuracy)
Which nursing intervention is least likely to be required if a patient
experiences a heart rate increase of 10 beats per minute with any
exercise and has fatigue upon exertion?
1
Teach the patient how to restrict fluids.
2
Provide a diet with a low sodium content.
3
Teach the patient about home oxygen therapy.
4
Help the patient plan a low-calorie and high-protein diet. - answer 3
The least likely nursing intervention is to teach the patient about
home oxygen therapy; instead, this is required if a patient has
impaired gas exchange related to decreased cardiac output. A heart
rate increase may indicate poor physical condition; therefore the
nurse may teach the patient how to restrict fluids and help him or
her plan a low-sodium, low-calorie, high-protein diet.
A patient reports dizziness, light-headedness, and nausea. The
nursing diagnosis is orthostatic hypotension. The nurse would take
precautions to prevent orthostatic hypotension when changing the
body from which position?
1
Vertical to horizontal
2
Horizontal to vertical
,3
Supine to prone
4
Standing to sitting - answer 2
Orthostatic hypotension is defined as a drop in blood pressure that
occurs when a patient shifts from a horizontal to a vertical position.
When there is such a change in position, the blood moves from the
central to the peripheral circulation. This causes a sudden drop in
blood pressure. When a patient changes his or her position from
vertical to horizontal, it does not cause a decrease in blood
pressure. A change from a supine to a prone position does not alter
blood pressure. A shift from a standing to a sitting position does not
cause a drop in blood pressure.
Arrange the steps of walking with a cane in the correct order.
1.
The weaker leg is moved forward to the cane.
2.
The stronger leg is advanced past the cane.
3.
Have the patient keep the cane on the stronger side of the body.
4.
The patient places the cane forward 15 to 25 cm, keeping body
weight on both legs. - answer 3. Have the patient keep the cane on
the stronger side of the body.
4. The patient places the cane forward 15 to 25 cm, keeping body
weight on both legs.
1. The weaker leg is moved forward to the cane
2. The stronger leg is advanced past the cane.
The patient keeps the cane on the stronger side of the body. The
patient then places the cane forward 15 to 25 cm, keeping body
, weight on both legs. This provides maximum support to the body.
The weaker leg is moved forward to the cane so body weight is
divided between the cane and the stronger leg. The stronger leg is
then advanced past the cane so the weaker leg and the body weight
are supported by the cane.
Which physiological factor would influence a patient's activity
tolerance?
1
Age
2
Pain
3
Depression
4
Motivation - answer 2
Pain is the physiological factor that influences a patient's activity
tolerance, the response a patient has to the type and amount of
exercise he or she is performing. While age, depression, and
motivation affect activity tolerance as well, age is considered a
developmental factor, and depression and motivation are emotional
factors.
When teaching the patient about the use of canes, which
information would the nurse include? Select all that apply. One,
some, or all responses may be correct.
1
Canes are lightweight, easily movable devices made of wood or
metal.
2
They should be of a length equal to the distance between the
greater trochanter and the floor.
updated 2025-2026(100%
verified for accuracy)
Which nursing intervention is least likely to be required if a patient
experiences a heart rate increase of 10 beats per minute with any
exercise and has fatigue upon exertion?
1
Teach the patient how to restrict fluids.
2
Provide a diet with a low sodium content.
3
Teach the patient about home oxygen therapy.
4
Help the patient plan a low-calorie and high-protein diet. - answer 3
The least likely nursing intervention is to teach the patient about
home oxygen therapy; instead, this is required if a patient has
impaired gas exchange related to decreased cardiac output. A heart
rate increase may indicate poor physical condition; therefore the
nurse may teach the patient how to restrict fluids and help him or
her plan a low-sodium, low-calorie, high-protein diet.
A patient reports dizziness, light-headedness, and nausea. The
nursing diagnosis is orthostatic hypotension. The nurse would take
precautions to prevent orthostatic hypotension when changing the
body from which position?
1
Vertical to horizontal
2
Horizontal to vertical
,3
Supine to prone
4
Standing to sitting - answer 2
Orthostatic hypotension is defined as a drop in blood pressure that
occurs when a patient shifts from a horizontal to a vertical position.
When there is such a change in position, the blood moves from the
central to the peripheral circulation. This causes a sudden drop in
blood pressure. When a patient changes his or her position from
vertical to horizontal, it does not cause a decrease in blood
pressure. A change from a supine to a prone position does not alter
blood pressure. A shift from a standing to a sitting position does not
cause a drop in blood pressure.
Arrange the steps of walking with a cane in the correct order.
1.
The weaker leg is moved forward to the cane.
2.
The stronger leg is advanced past the cane.
3.
Have the patient keep the cane on the stronger side of the body.
4.
The patient places the cane forward 15 to 25 cm, keeping body
weight on both legs. - answer 3. Have the patient keep the cane on
the stronger side of the body.
4. The patient places the cane forward 15 to 25 cm, keeping body
weight on both legs.
1. The weaker leg is moved forward to the cane
2. The stronger leg is advanced past the cane.
The patient keeps the cane on the stronger side of the body. The
patient then places the cane forward 15 to 25 cm, keeping body
, weight on both legs. This provides maximum support to the body.
The weaker leg is moved forward to the cane so body weight is
divided between the cane and the stronger leg. The stronger leg is
then advanced past the cane so the weaker leg and the body weight
are supported by the cane.
Which physiological factor would influence a patient's activity
tolerance?
1
Age
2
Pain
3
Depression
4
Motivation - answer 2
Pain is the physiological factor that influences a patient's activity
tolerance, the response a patient has to the type and amount of
exercise he or she is performing. While age, depression, and
motivation affect activity tolerance as well, age is considered a
developmental factor, and depression and motivation are emotional
factors.
When teaching the patient about the use of canes, which
information would the nurse include? Select all that apply. One,
some, or all responses may be correct.
1
Canes are lightweight, easily movable devices made of wood or
metal.
2
They should be of a length equal to the distance between the
greater trochanter and the floor.
