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Which of the following diet instructions are appropriate when teaching a client in the early stages of cirrhosis about nutritional needs? Select all that apply.
- A. Limit your caloric intake so that you don't become overweight.'
- B. An adequate intake of protein is important to your health.'
- C. I encourage you to eat small, frequent meals.'
- D. Restrict your fluid intake to 1,000 mL/day.'
- E. Limit your alcohol intake to one glass of wine daily.'
Correct Answer: B,C
Rationale: Adequate protein supports liver repair, and small, frequent meals reduce metabolic stress in early cirrhosis. Alcohol should be avoided, and fluid restriction is not typically needed early on.
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A client with a history of type 2 diabetes is prescribed insulin glargine (Lantus). The nurse should instruct the client to:
- A. Take the insulin at bedtime.
- B. Mix the insulin with short-acting insulin.
- C. Take the insulin with meals.
- D. Stop the insulin if blood glucose normalizes.
Correct Answer: A
Rationale: Insulin glargine, a long-acting insulin, is typically taken at bedtime for basal coverage.
A client with a suspected stroke is admitted to the emergency department. What is the nurse's priority action?
- A. Administer aspirin as ordered.
- B. Assess neurological status.
- C. Prepare for a CT scan.
- D. Monitor blood pressure.
Correct Answer: B
Rationale: Assessing neurological status is the priority to establish a baseline and detect changes in a suspected stroke, guiding urgent interventions.
The nurse is evaluating a diabetic client's understanding of the signs of hyperglycemia. Which statement by the client reflects an understanding?
- A. I may become diaphoretic and faint.
- B. I may notice signs of fatigue, dry skin, and increased urination.
- C. I need to take an extra diabetic pill if my blood glucose is greater than 300.
- D. I should restrict my fluid intake if my blood glucose is greater than 250.
Correct Answer: B
Rationale: Fatigue, dry skin, polyuria, and polydipsia are classic symptoms of hyperglycemia. Fatigue occurs because of lack of energy from the inability of the body to use glucose. Dry skin occurs secondary to dehydration related to polyuria. Polydipsia occurs secondary to fluid loss. Diaphoresis is associated with hypoglycemia. A client should not take extra hypoglycemic agents to reduce an elevated blood glucose level. A client with hyperglycemia becomes dehydrated secondary to the osmotic effect of the elevated glucose; therefore, the client must increase fluid intake.
A client with chronic renal failure is receiving hemodialysis. Which dietary restriction should the nurse emphasize?
- A. Low-protein diet.
- B. High-sodium diet.
- C. Low-potassium diet.
- D. High-calcium diet.
Correct Answer: C
Rationale: A low-potassium diet is critical in chronic renal failure to prevent hyperkalemia, which can cause cardiac complications.
A client with a history of atrial fibrillation is prescribed warfarin (Coumadin). The nurse should teach the client to avoid which of the following foods?
- A. Green leafy vegetables.
- B. Citrus fruits.
- C. Whole grains.
- D. Lean meats.
Correct Answer: A
Rationale: Green leafy vegetables are high in vitamin K, which can reduce warfarin's anticoagulant effect.