A nurse is creating a plan of care for a newly admitted client who is visually impaired. Which of the following interventions should the nurse include in the plan?

Place a sign on the client's door indicating visual impairment.

Provide the client with a brightly colored plate and utensils.

When ambulating with the client, grasp the client's arm above the elbow.

Speak in an elevated tone of voice when providing care.

Answer and Explanation

The Correct Answer is C

A) Place a sign on the client's door indicating visual impairment:
While indicating the client’s visual impairment to staff can be helpful, privacy and dignity should also be considered. Alternative methods to inform the staff without compromising the client's privacy should be used.

B) Provide the client with a brightly colored plate and utensils:
Brightly colored plates and utensils can help clients with partial vision impairment but may not be significantly beneficial for those who are fully visually impaired.

C) When ambulating with the client, grasp the client's arm above the elbow:
Grasping the client's arm above the elbow is an effective way to guide a visually impaired person. This allows the client to follow the nurse's movements more naturally and ensures better support and guidance.

D) Speak in an elevated tone of voice when providing care:
Elevating the tone of voice is unnecessary and may be misinterpreted as condescending. Clear, normal, and respectful communication is essential for all clients, regardless of visual impairment.

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Correct Answer is ["B","C","E"]

Explanation

A) Urticaria:
Urticaria, or hives, is a skin reaction characterized by itchy, raised welts. It is not typically associated with a small bowel obstruction, which primarily affects the gastrointestinal system rather than the skin.

B) Vomiting:
Vomiting is a common symptom of a complete small bowel obstruction. It occurs due to the blockage in the intestines, which prevents the passage of contents, leading to nausea and vomiting as the body tries to expel the obstruction.

C) Distended abdomen:
A distended abdomen is expected in cases of small bowel obstruction. The blockage causes a buildup of gas and fluids, leading to abdominal swelling and distention as the normal passage of intestinal contents is impeded.

D) Fluid overload:
Fluid overload is not a typical manifestation of a small bowel obstruction. Instead, dehydration and electrolyte imbalances are more likely due to vomiting and the inability to absorb fluids and nutrients properly.

E) Obstipation:
Obstipation, or severe constipation with an inability to pass stool or gas, is a key sign of a complete small bowel obstruction. The obstruction prevents the normal movement of intestinal contents, leading to a cessation of bowel movements.

A. "I should choose cold foods over warm foods." B. "I should follow a low-protein diet." C. "I should increase my fiber intake to 35 grams a day." D. "I should eat small, frequent meals throughout the day."

Correct Answer is D

Explanation

A) "I should choose cold foods over warm foods.": Cold foods are not necessarily better than warm foods for someone with ulcerative colitis. The choice of temperature depends on individual tolerance, but there is no specific recommendation that cold foods are preferable. Warm, easily digestible foods can also be soothing and well-tolerated.

B) "I should follow a low-protein diet.": This is not an accurate recommendation for ulcerative colitis. Protein is essential for healing and maintaining muscle mass, especially if the client is experiencing malnutrition or weight loss due to the disease. A balanced diet with adequate protein is important for overall health.

C) "I should increase my fiber intake to 35 grams a day.": High fiber intake can be problematic for those with active ulcerative colitis as it may increase symptoms such as bloating, gas, and diarrhea. It is often recommended to limit fiber intake during flare-ups and focus on low-residue diets to reduce bowel activity.

D) "I should eat small, frequent meals throughout the day.": This is a recommended approach for managing ulcerative colitis. Small, frequent meals can help ensure adequate nutrient intake without overwhelming the digestive system, which can help manage symptoms and improve overall comfort.

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A nurse is creating a plan of care for a newly admitted client who is visually impaired. Which of the following interventions should the nurse include in the plan?

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