A client has just completed eating her noon meal.
Which nutritional documentation is the most informative?
Patient drank most of her liquids without difficulty.
Patient ate all her lunch.
Patient ate 50% of a heart-healthy diet without difficulty, and drank 360 mL of liquids.
Assisted patient with feeding a liquid diet, chokes frequently.
The Correct Answer is C
Choice A rationale
Stating that the patient drank most liquids without difficulty is a general observation but lacks specific details about the quantity consumed and the type of diet. It provides limited nutritional information.
Choice B rationale
Saying the patient ate all her lunch is brief but doesn't specify the type or amount of food consumed. "Lunch" can vary greatly in nutritional content, making this documentation less informative.
Choice C rationale
This documentation provides specific details about the patient's intake, including the percentage of the heart-healthy diet consumed (50%), indicating the amount of solid food, and the exact volume of liquids ingested (360 mL). It also notes the absence of difficulty, offering a more comprehensive nutritional picture.
Choice D rationale
Documenting assistance with feeding a liquid diet and frequent choking is important for safety but doesn't quantify the amount of liquid consumed or the patient's overall nutritional intake from the meal.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["2"]
Explanation
Step 1 is: The physician ordered 40 mg of pantoprazole.
Step 2 is: The available tablets are 20 mg each.
Step 3 is: To find the number of tablets needed, divide the ordered dose by the available dose: 40 mg ÷ 20 mg/tablet.
Step 4 is: 40 ÷ 20 = 2. Final Answer: The nurse will administer 2 tablets. .
Correct Answer is B
Explanation
Choice A rationale
While a sudden and significant asymmetry in breast size or shape could indicate a new issue such as inflammation or a growth and warrants investigation, a slight, long-standing asymmetry is quite common among women. It does not automatically signify a pathological condition.
Choice B rationale
It is a well-established fact that many women have some degree of natural asymmetry in their breast size and shape. However, it is crucial for the nurse to ascertain if this finding is new for the patient. A recent change in asymmetry could be a sign of a developing condition that requires further evaluation.
Choice C rationale
While any new or significant asymmetry should be evaluated by a physician to rule out underlying issues, a long-standing, slight asymmetry is a common physiological variation and does not necessarily require immediate referral unless other concerning signs or symptoms are present.
Choice D rationale
Breastfeeding can sometimes cause temporary changes in breast size due to milk production and engorgement, and one breast might produce slightly more milk than the other. However, a noticeable and persistent asymmetry might predate breastfeeding or persist beyond it, and while it might be benign, attributing it solely to breastfeeding without further assessment of its history is not prudent. .
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