A nurse is caring for a client at the endocrinologist's office.

Exhibits

The client sees the diabetic nurse educator. Click to highlight the findings that indicate an understanding of the diabetic foot care education the client received. To deselect a finding, click on the finding again.

"I understand that I need to inspect my feet daily. I will dry my feet thoroughly when I get out of the shower. It is important to apply lotion to my feet and especially my toes to keep my skin in good health. That will prevent any sores on my feet. I will be very careful when I cut my toenails and will be sure to cut them straight across and then file the edges with an emery board. I will wear closed toed shoes. I am glad I can still go barefoot in the house because I never wear shoes at home. If I have any foot sores or corns come up, I will see my doctor or go to a podiatrist instead of treating it myself."

I understand that I need to inspect my feet daily.

I will dry my feet thoroughly when I get out of the shower.

I will be very careful when I cut my toenails and will be sure to cut them straight across and then file the edges with an emery board.

I will wear closed toed shoes.

If I have any foot sores or corns come up, I will see my doctor or go to a podiatrist instead of treating it myself.

Answer and Explanation

The Correct Answer is ["A","B","C","D","E"]

Rationale:

A.   "I understand that I need to inspect my feet daily."Daily foot inspection is essential for individuals with diabetes to identify any cuts, blisters, or signs of infection early. Reduced sensation due to peripheral neuropathy can lead to unnoticed injuries that progress to serious complications if untreated.
B.   "I will dry my feet thoroughly when I get out of the shower." Keeping the feet dry, especially between the toes, helps prevent fungal infections and skin breakdown. Moist environments encourage fungal growth, which can worsen foot health in diabetic clients.
C.   "It is important to apply lotion to my feet and especially my toes to keep my skin in good health." While moisturizing helps prevent dry, cracked skin, lotion should not be applied between the toes. Moisture trapped between the toes increases the risk of fungal infections and skin maceration in diabetic clients.
D.   "I will be very careful when I cut my toenails and will be sure to cut them straight across and then file the edges with an emery board." Cutting toenails straight across and filing the edges helps prevent ingrown toenails and reduces the risk of accidental skin injury. Diabetic clients are advised to be cautious during nail care due to impaired healing and infection risk.
E.   "I will wear closed toed shoes." Wearing closed-toed shoes protects the feet from injury and trauma. Open-toed shoes or sandals may expose the feet to injury, and diabetic clients may not feel injuries due to neuropathy.
F.   "I am glad I can still go barefoot in the house because I never wear shoes at home."Going barefoot, even indoors, increases the risk of stepping on sharp objects and sustaining unnoticed injuries. Clients with diabetes should always wear well-fitting shoes or protective footwear, even at home.
G.   "If I have any foot sores or corns come up, I will see my doctor or go to a podiatrist instead of treating it myself." Diabetic clients should avoid self-treating foot problems like sores or corns. Prompt evaluation by a healthcare provider prevents complications like infections or ulcers, which can escalate quickly in this population.

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Correct Answer is C

Explanation

Rationale:

A. "Cauliflower is a good dietary choice”. Cauliflower is a gas-forming vegetable that can increase abdominal discomfort in clients with gallbladder disease. It is not typically recommended during symptomatic periods or recovery from cholelithiasis.

B. "Increase the amount of egg yolks in your diet." Egg yolks are high in cholesterol and fat, which can trigger gallbladder contractions and worsen symptoms in clients with cholelithiasis. These should be limited or avoided.

C. "Select desserts such as angel-food cake." Angel-food cake is low in fat and cholesterol, making it an appropriate dessert option for individuals with gallbladder disease. Low-fat and non-irritating foods are key to managing symptoms.

D. "Eat choice or prime cuts of meat." Choice or prime cuts tend to have a higher fat content. High-fat meats can exacerbate symptoms by stimulating bile production and gallbladder contractions, which should be avoided in cholelithiasis.

A. WBC count B. Intake and output C. ABGs D. Blood glucose level

Correct Answer is C

Explanation

Rationale:

A. WBC count: Monitoring the white blood cell count is useful for detecting infection, but heroin toxicity primarily affects the respiratory system. An elevated or normal WBC does not provide immediate information about the client's ventilation or gas exchange status.

B. Intake and output: Tracking fluid balance is important for overall patient monitoring, especially in critically ill clients. However, it does not provide direct insight into the effectiveness of mechanical ventilation or the client's oxygenation status.

C. ABGs: Arterial blood gases are the priority assessment because they directly measure the client's oxygenation, ventilation (CO₂ removal), and acid-base status. Since heroin toxicity can cause respiratory depression, ABGs are essential to evaluate the effectiveness of mechanical ventilation.

D. Blood glucose level: Although monitoring glucose is important in critically ill clients, heroin use is not typically associated with hypo- or hyperglycemia. Blood glucose assessment is not as urgent as evaluating respiratory function in this scenario.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is providing teaching about dietary options for a client who has cholelithiasis. Which of the following statements should the nurse include in the teaching?

Correct Answer is C

Explanation

A nurse is caring for a client who is intubated and receiving mechanical ventilation for heroin toxicity. Which of the following assessments is the nurse's priority?

Correct Answer is C

Explanation

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