Nokea
A nurse is teaching a client who has a new diagnosis of diabetes mellitus about foot care. Which of the following instructions should the nurse include in the teaching?
- A. Soak feet twice daily.
- B. Round the edges of toenails when trimming
- C. Use moisturizing lotion between the toes.
- D. Wear clean cotton socks every day.
Correct Answer: D
Rationale: The correct answer is D: Wear clean cotton socks every day. This instruction is crucial for diabetic foot care as it helps prevent moisture buildup, reduces the risk of infections, and maintains proper foot hygiene. Clean cotton socks minimize friction, provide cushioning, and promote good circulation.
Rationale for other choices:
A: Soaking feet twice daily can lead to dry skin, increasing the risk of skin breakdown and infection.
B: Rounding the edges of toenails can cause injury and increase the risk of ingrown toenails.
C: Using moisturizing lotion between the toes can create a moist environment, promoting fungal growth and skin maceration.
You may also like to solve these questions
Which of the following actions should the nurse take to evaluate the effectiveness of the procedure?
- A. Examine for leakage at the site of the procedure
- B. Compare the client's current weight with preprocedural weight
- C. Confirm that the client is able to urinate.
- D. Check the client's serum albumin levels.
Correct Answer: B
Rationale: The correct answer is B: Compare the client's current weight with preprocedural weight. This is the most appropriate action to evaluate the effectiveness of the procedure because changes in weight can indicate fluid retention or loss, which are common outcomes of many procedures. This comparison helps assess if the procedure had the desired effect on the client's fluid status.
Examine for leakage at the site of the procedure (A) is not the best action to evaluate the procedure's effectiveness as leakage may not always correlate with the overall success of the procedure. Confirming that the client is able to urinate (C) is important but may not directly indicate the effectiveness of the procedure. Checking the client's serum albumin levels (D) is relevant for assessing nutritional status but may not directly evaluate the procedure's effectiveness.
Which of the following statements by the parent indicates an understanding of the teaching?
- A. After 5 to 10 minutes when the breast is emptied, my baby should be removed from the breast.â€
- B. Manually expressing my milk will decrease my milk supply.
- C. My baby should always start on the same breast when feeding.â€
- D. The more my baby is at the breast sucking, the mare milk I will produce.â€
Correct Answer: D
Rationale: The correct answer is D because it reflects an understanding of the concept of supply and demand in breastfeeding. The statement acknowledges that the more the baby suckles, the more milk the parent will produce. This aligns with the principle that frequent and effective nursing stimulates milk production.
Choice A is incorrect because it suggests limiting nursing time, which can hinder milk production. Choice B is incorrect as manual expression can actually help increase milk supply. Choice C is incorrect as it is recommended to offer both breasts during a feeding session to ensure the baby receives enough hindmilk.
Which of the following actions should the nurse take?
- A. Infuse the medication over 10 min
- B. Instruct the client to notify the provider if diarrhea develops
- C. Refrigerate the medication after reconstitution.
- D. Check the client for a sulfa allergy.
Correct Answer: B
Rationale: The correct answer is B: Instruct the client to notify the provider if diarrhea develops. This action is important because diarrhea can be a potential side effect of medication, especially antibiotics, and may indicate a serious adverse reaction. It is crucial for the client to inform the provider promptly to prevent complications.
Choice A is incorrect as it refers to a specific administration instruction for a medication, not related to client monitoring. Choice C is incorrect as it pertains to storage of medication, not client education. Choice D is incorrect as it focuses on assessing for a specific allergy, not related to ongoing client monitoring.
Which of the following findings places the client at risk if he receives alteplase?
- A. Family history of malignant hypertension
- B. Hip arthroplasty 1 week ago
- C. Chronic obstructive pulmonary disease
- D. Acute renal failure 6 months ago
Correct Answer: B
Rationale: Recent surgeries increase bleeding risks with thrombolytics.
A nurse is caring for a client who is experiencing expressive aphasia and right hemiparesis following a stroke. Which of the following actions by the nurse best promotes communication among staff caring for the client?
- A. Posting swallowing precautions at the head of the client’s bed
- B. Noting changes in the treatment plan in the client's medical record
- C. Recording the client's progress in the nurses’ notes
- D. Having interdisciplinary team meetings for the client on a regular basis.
Correct Answer: D
Rationale: Rationale for the Correct Answer (D): Having interdisciplinary team meetings for the client on a regular basis is the best action to promote communication among staff caring for the client. This approach ensures that all healthcare team members are regularly updated on the client's condition, progress, and treatment plan. It allows for collaborative decision-making and coordination of care, leading to a holistic and effective approach to managing the client's needs. Additionally, it provides an opportunity for staff to discuss any challenges, share insights, and adjust interventions as needed to optimize the client's outcomes.
Summary of Incorrect Choices:
A: Posting swallowing precautions at the head of the client's bed is important for safety but does not directly promote communication among staff.
B: Noting changes in the treatment plan in the client's medical record is essential for documentation but may not facilitate real-time communication among staff members.
C: Recording the client's progress in the nurses' notes is necessary for tracking the client's status but does not ensure comprehensive communication among all team