A 65 year old client is being seen at the outpatient clinic for a routine physical exam. The abdominal assessment shows distention, firmness, and the client states tenderness throughout the 4 quadrants. Upon further questioning of the client the following is determined; a slight decrease in appetite. consumes 320 mL of water per day along with 320 mL of other fluids such as coffee and soda, snacks frequently on cheese and crackers rather than full meals, and does not get much activity. Client states they have one to two bowel movements per week of hard formed stool. Based on the physical assessment and the answered questions what would be the recommended interventions for this client?
SELECT ALL THAT APPLY.
Administer an enema twice a week to stimulate peristalsis.
Eat a high- fiber diet that includes whole grains, bran, and beans daily.
Engage in regular exercise such as walking 20-30 minutes daily.
Consume only well-cooked fruits and vegetables daily.
Increase consumption of eggs, meat, and dairy daily.
Correct Answer : B,C
A. Administering an enema may not be the first-line intervention and may have potential risks. Dietary and lifestyle changes are usually recommended first.
B. A high-fiber diet promotes regular bowel movements and helps prevent constipation.
C. Regular exercise, such as walking, can stimulate bowel activity and improve overall health.
D. Well-cooked fruits and vegetables are beneficial, but the emphasis should be on increasing fiber intake.
E. Increasing consumption of eggs, meat, and dairy may not address the constipation issue and might contribute to a low-fiber diet.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Emphysema is not associated with bronchodilation; it is characterized by the destruction of alveoli.
B. Emphysema does not directly increase oxygen saturation; it impairs gas exchange.
C. Emphysema does not affect systole; it primarily affects lung function.
D. Emphysema decreases lung tissue elasticity, leading to decreased compliance, making it harder for the lungs to inflate and deflate.
Correct Answer is D
Explanation
A. The helping relationship phases and nursing process are not specific communication tools for addressing safety concerns.
B. The nursing process is a systematic approach to patient care but is not a communication tool specifically for addressing safety concerns.
C. SBAR (Situation, Background, Assessment, Recommendation) is a structured communication tool commonly used in healthcare settings for reporting and addressing safety concerns.
D. CUS (I am concerned, I feel uncomfortable, this is unsafe) is a communication tool for expressing concerns, for instance, by saying something like this: "I am concerned about the patient's risk for falls. I feel uncomfortable seeing you walk the patient without a gait belt or non-skid socks. This is unsafe for the patient and could cause harm or injury. Please use a gait belt and non-skid socks when walking the patient." This way, the nurse can convey their message in a clear, respectful, and assertive way, and prompt the UAP to take action to ensure the patient's safety.
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