A nurse is collecting data from a client who has pernicious anemia. The nurse should identify that which of the following findings increases the client's risk for injury?
Uses a firm-bristled toothbrush
Increased intake of green, leafy vegetables
Drinks 2,500 mL of fluid per day
Wears a face mask around others
The Correct Answer is A
Choice A Reason:
Uses a firm-bristled toothbrush is correct. Clients with pernicious anemia often have neurological symptoms due to vitamin B12 deficiency. One of these neurological symptoms can be impaired proprioception, which is the body's ability to sense its position and movement in space. Using a firm-bristled toothbrush can increase the risk of injury because the client may have difficulty with fine motor skills and controlling the pressure applied to their teeth and gums, leading to potential gum injury or bleeding.
Choice B Reason:
Increased intake of green, leafy vegetables is incorrect. Increasing the intake of foods rich in vitamin B12, such as green, leafy vegetables, can be beneficial for clients with pernicious anemia, as it can help with vitamin B12 absorption and overall health.
Choice C Reason:
Drinks 2,500 mL of fluid per day is incorrect. Maintaining adequate hydration is essential for overall health and does not increase the risk of injury.
Choice D Reason:
Wears a face mask around others is incorrect. Wearing a face mask around others, especially in situations where respiratory precautions are necessary, is a preventive measure to reduce the risk of infection and does not inherently increase the risk of injury.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A Reason:
Applying antibiotic ointment is typically not recommended after a Plastibell circumcision, as it may interfere with the natural healing process.
Choice B Reason:
Ensuring that the baby's diaper is applied snugly can potentially cause friction and discomfort around the circumcision site. It's generally recommended to use loose-fitting diapers to avoid irritation.
Choice C Reason:
Wiping away yellow crusts (scabs) that form around the incision is not advised, as this can disrupt the healing process. It's best to let these crusts fall off naturally as the area heals.
Choice D Reason:
"I will apply pressure with gauze if I see bleeding." This statement by the parent indicates an understanding of circumcision care following a Plastibell circumcision. Applying gentle pressure with gauze if bleeding occurs is an appropriate response to manage bleeding and promote clotting at the circumcision site.
Correct Answer is A
Explanation
Choice A Reason:
"I would like to observe you using your glucometer. “To evaluate the client's use of a glucometer effectively, the nurse should ask the client to demonstrate how they use the device to check their blood glucose levels. This allows the nurse to directly observe the client's technique, including proper hand hygiene, fingerstick procedure, test strip insertion, and interpretation of results. It also provides an opportunity to correct any errors or misconceptions in real-time and ensure the client is using the glucometer correctly.
Choice B Reason:
"Show me what blood glucose supplies you have available." This question assesses the client's supply inventory but does not assess their actual use of the glucometer.
Choice C Reason:
"Let me demonstrate for you how to use this machine correctly." This option involves the nurse demonstrating the use of the glucometer to the client, which may be helpful as part of teaching but does not evaluate the client's current proficiency in using the device.
Choice D Reason:
"Tell me how long you have been using this glucometer." This question inquiries about the client's history of using the glucometer but does not assess their current competence in using it.
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