Nokea
A client with osteoporosis is being taught about dietary management. Which statement indicates an understanding of the teaching?
- A. I should increase my intake of foods high in vitamin D.
- B. I should decrease my intake of foods high in calcium.
- C. I should increase my intake of foods high in phosphorus.
- D. I should decrease my intake of foods high in potassium.
Correct Answer: A
Rationale: The correct answer is A. Increasing intake of foods high in vitamin D is beneficial for improving calcium absorption and managing osteoporosis. Vitamin D helps the body absorb calcium, which is essential for bone health and can aid in managing osteoporosis effectively. Choice B is incorrect because reducing calcium intake would be counterproductive for a client with osteoporosis, as calcium is crucial for bone strength. Choice C is incorrect as phosphorus, while important for bone health, does not directly impact osteoporosis management as much as vitamin D and calcium. Choice D is incorrect as potassium is not directly linked to osteoporosis management, and reducing its intake is not typically part of dietary recommendations for osteoporosis.
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A client has a prescription for a soft diet. Which of the following foods should the nurse offer?
- A. Fresh apples
- B. Mashed potatoes
- C. Raw carrots
- D. Nuts
Correct Answer: B
Rationale: When a client is on a soft diet, it is important to offer foods that are easy to chew and swallow. Mashed potatoes are a suitable choice for a soft diet as they are soft in texture and easy to digest. Fresh apples, raw carrots, and nuts are harder and may not be appropriate for a soft diet. Fresh apples and raw carrots require more chewing, and nuts are hard and crunchy, which can be difficult for someone on a soft diet to consume. Therefore, mashed potatoes are the correct option for a client on a soft diet.
Miss Imelda asked you, What is WET TO DRY Dressing method? Your best response is
- A. It is a type of mechanical debridement using Wet dressing that is applied and left to dry to remove dead tissues
- B. It is a type of surgical debridement with the use of Wet dressing to remove the necrotic tissues
- C. It is a type of dressing where in, The wound is covered with Wet or Dry dressing to prevent contamination
- D. It is a type of dressing where in, A cellophane or plastic is placed on the wound over a wet dressing to stimulate healing of the wound in a wet medium
Correct Answer: A
Rationale: The wet-to-dry dressing method (A) is a mechanical debridement technique where a wet gauze is applied to a wound, then dries, adhering to and removing necrotic tissue when peeled off. Surgical debridement (B) involves cutting, not dressings. Option C misrepresents it as a protective dressing, ignoring debridement. Option D describes wet-to-moist dressings, not wet-to-dry. Wet-to-dry targets dead tissue removal, aiding healing in wounds like Imelda's, making A accurate and the best response.
A client has a tracheostomy and requires suctioning. Which of the following actions should be taken?
- A. Hyperoxygenate the client before suctioning
- B. Insert the catheter while exhalation
- C. Apply suction after inserting the catheter
- D. Limit suctioning to no more than 15 seconds
Correct Answer: A
Rationale: Hyperoxygenating the client before suctioning is crucial to prevent hypoxia during the procedure. By using a manual resuscitation bag with 100% oxygen, the nurse should provide several breaths to the client to ensure sufficient oxygenation before starting suctioning. This approach helps maintain oxygen levels and decreases the risk of hypoxia, which may arise when suctioning interrupts the normal respiratory process. Choices B, C, and D are incorrect because inserting the catheter during exhalation, applying suction while inserting the catheter, and limiting suctioning to 15 seconds do not address the priority of hyperoxygenating the client to prevent hypoxia.
A client is receiving discharge teaching after a total hip arthroplasty. Which of the following instructions should be included?
- A. Cross your legs at the ankles while sitting
- B. Avoid bending your hips more than 90 degrees
- C. Sit in a low-seated chair
- D. Twist your body when standing up
Correct Answer: B
Rationale: To prevent dislocation of the hip prosthesis, the client should avoid bending their hips more than 90 degrees. Excessive bending at the hips can increase the risk of hip dislocation, which is a significant concern following total hip arthroplasty. Sitting with crossed legs at the ankles (choice A) can also increase the risk of hip dislocation and should be avoided. Sitting in a low-seated chair (choice C) can make it more challenging for the client to stand up safely. Twisting the body when standing up (choice D) can also strain the hip joint and increase the risk of dislocation. Therefore, the correct instruction to include during discharge teaching is to avoid bending the hips more than 90 degrees.
Which of the following clinical findings is expected in a patient who has undergone gastric lavage and prolonged vomiting?
- A. Decreased serum pH
- B. Increased serum bicarbonate level
- C. Increased serum oxygen level
- D. Decreased serum osmotic level
Correct Answer: A
Rationale: Prolonged vomiting and gastric lavage lose stomach acid (HCl), causing metabolic alkalosis elevated pH, not decreased (acidosis). Bicarbonate rises as the body compensates, not oxygen or osmolarity, which are unrelated. Nurses monitor for alkalosis symptoms (e.g., tetany), correcting with fluids like saline, restoring acid-base balance disrupted by gastric content loss.