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A nurse is discussing denture care with the partner of a client who is unable to perform oral hygiene. Which of the following should be included in the discussion?
- A. Floss dentures as part of daily cleaning.
- B. Wipe dentures before storing them in a dry container at night.
- C. Wrap gloved fingers with gauze to remove dentures.
- D. Use a washcloth to clean the denture surfaces.
Correct Answer: C
Rationale: The correct answer is C: 'Wrap gloved fingers with gauze to remove dentures.' This method provides a safe and effective way to remove dentures without causing damage. Choice A is incorrect because flossing dentures is not recommended. Choice B is incorrect as it suggests wiping dentures and storing them dry, which is not the best practice. Choice D is incorrect because using a washcloth may not effectively clean all denture surfaces.
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A nurse is teaching a nutrition class for clients who have type 2 diabetes mellitus. Which of the following statements should the nurse include about management of acute illness?
- A. Consume carbs every 3-4 hrs
- B. Decrease fluid intake to 1000 mL per day
- C. Monitor blood glucose twice per day
- D. Check urine for ketones every 24 hrs
Correct Answer: A
Rationale: The correct statement is to 'Consume carbs every 3-4 hours.' During acute illness, it is important to maintain a consistent carbohydrate intake to help manage blood glucose levels for clients with type 2 diabetes. This frequent consumption can prevent hypoglycemia and provide energy needed during illness. Decreasing fluid intake (choice B) is not recommended during acute illness, as hydration is crucial to prevent complications. Monitoring blood glucose (choice C) more frequently than twice a day is necessary during acute illness. Checking urine for ketones (choice D) should be done more frequently than once every 24 hours during illness to monitor for diabetic ketoacidosis.
A healthcare professional is reviewing the lab findings of a client who has Clostridium Difficile. Which of the following findings should indicate to the healthcare professional that the client is experiencing Fluid Volume Deficit?
- A. Hct 53%
- B. Potassium 3.5
- C. Sodium 145
- D. HbA1c 5
Correct Answer: A
Rationale: An elevated hematocrit level (Hct 53%) indicates hemoconcentration, a sign of fluid volume deficit. Hct measures the percentage of red blood cells in the blood and increases when there is a decrease in plasma volume, as seen in fluid volume deficit. Choices B, C, and D do not directly relate to fluid volume status. Potassium and sodium levels are more indicative of electrolyte imbalances, while HbA1c reflects average blood sugar levels over the past 2-3 months and is not specific to fluid volume status.
A nurse is caring for an older adult client who reports difficulty chewing due to ill-fitting dentures. Which of the following foods should the nurse recommend for the client?
- A. Dried fruit
- B. Roast beef
- C. Tuna fish
- D. Apple slices
Correct Answer: C
Rationale: The correct answer is C: Tuna fish. Tuna fish is a soft and easy-to-chew option, suitable for clients with ill-fitting dentures. Dried fruit (choice A) can be tough to chew and may stick to the dentures, causing discomfort. Roast beef (choice B) requires significant chewing effort and may not be suitable for someone with difficulty chewing. Apple slices (choice D) are crunchy and hard, which can be challenging for individuals with ill-fitting dentures.
A nurse is caring for four clients. The nurse should plan to administer total parenteral nutrition for which of the following clients?
- A. A client who is postoperative following a laminectomy and is receiving IV PCA
- B. A client who has dysphagia and does not recognize his family
- C. A client who has COPD and is going home with oxygen
- D. A client who has colon cancer and will undergo a hemicolectomy
Correct Answer: D
Rationale: Total parenteral nutrition (TPN) is essential for clients undergoing significant surgical procedures like a hemicolectomy to ensure they receive adequate nutrition when oral intake is not possible. Choices A, B, and C do not typically require TPN. Choice A is managing postoperative pain with IV PCA, choice B is likely to need alternative feeding methods due to dysphagia, and choice C is going home with oxygen for COPD management, which does not directly relate to the need for TPN.
A healthcare professional is reviewing the laboratory findings of a client who has heart failure. Which of the following findings indicates that the client is experiencing fluid volume excess?
- A. BUN 8 mg/dL
- B. Hgb 15 g/dL
- C. Creatinine 0.8 mg/dL
- D. Sodium 140 mEq/L
Correct Answer: A
Rationale: A BUN level of 8 mg/dL indicates fluid volume excess in a client with heart failure. BUN (Blood Urea Nitrogen) levels can be low in fluid overload due to hemodilution, a common occurrence in heart failure. High levels of BUN usually indicate dehydration or impaired renal function, which are not the case in fluid volume excess. Choices B, C, and D are within normal ranges and do not specifically indicate fluid volume excess.