Nokea
A client has been taking aluminum hydroxide 30 mL six times per day at home to treat his peptic ulcer. He tells the nurse that he has been unable to have a bowel movement for 3 days. Based on this information, the nurse would determine that which of the following is the most likely cause of the client's constipation?
- A. The client has not been including enough fiber in his diet
- B. The client needs to increase his daily exercise
- C. The client is experiencing a side effect of the aluminum hydroxide.
- D. The client has developed a gastrointestinal obstruction.
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
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The nurse instructs the nursing assistant on how to provide oral hygiene for a client who cannot perform this task for himself. Which of the following techniques should the nurse tell the assistant to incorporate into the client's daily care?
- A. Assess the oral cavity each time mouth care is given and record observations
- B. Use a soft toothbrush to brush the client's teeth after each meal
- C. Swab the client's tongue, gums, and lips with a soft foam applicator every 2 hours.
- D. Rinse the client's mouth with mouthwash several times a day.
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
The nurse is caring for a client following a Billroth II procedure. On review of the post-operative orders, which of the following, if prescribed, would the nurse question and verify?
- A. Irrigating the nasogastric tube
- B. Coughing a deep breathing exercises
- C. Leg exercises
- D. Early ambulation
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
The nurse is providing discharge instructions to a client following gastrectomy. Which measure will the nurse instruct the client to follow to assist in preventing dumping syndrome?
- A. Eat high-carbohydrate foods
- B. Limit the fluids taken with meals
- C. Ambulate following a meal
- D. Sit in a high-Fowlers position during meals
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
Which of the following would be an expected nutritional outcome for a client who has undergone a subtotal gastrectomy for cancer?
- A. Regain weight loss within 1 month after surgery
- B. Resume normal dietary intake of three meals per day
- C. Control nausea and vomiting through regular use of antiemetics
- D. Achieve optimal nutritional status through oral or parenteral feedings
Correct Answer: D
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
To accurately assess for jaundice in a patient with dark skin pigmentation, the nurse should examine which body areas?
- A. Nail beds
- B. Skin on the back of the hand
- C. Hard palate of the mouth
- D. Soles of the feet
Correct Answer: C
Rationale: To accurately assess for jaundice in a patient with dark skin pigmentation, the nurse should examine the hard palate of the mouth. Jaundice is best assessed in the sclera; however, in dark-skinned patients, normal yellow pigmentation may be present in the sclera, making it difficult to detect jaundice. Inspection of the hard palate for a yellow color can confirm the presence of jaundice. Cyanosis is best observed in the nail beds, not indicative of jaundice. While skin on the palm of the hand can indicate jaundice, the back of the hand is not a typical area for assessment. Jaundice can be assessed on the soles of the feet in dark-skinned patients, but it is better visualized in the hard palate for accurate evaluation.