A nurse is planning care for a client who is confined to bed. Which of the following actions should the nurse include in the plan?

Massage the client's red bony prominences.

Assess the client's skin for increased coolness.

Reposition the client every 2 hr.

Keep the client's skin moist.

Answer and Explanation

The Correct Answer is C

A. Massaging red bony prominences may cause further skin damage and increase the risk of pressure ulcers.

B. Skin should be assessed for warmth, redness, and integrity, but coolness is not necessarily an indicator of pressure injury.

C. Repositioning every 2 hours is essential for preventing pressure ulcers in bed-bound clients by relieving pressure on vulnerable areas.

D. Keeping the skin moist increases the risk of skin breakdown. It is important to keep the skin dry and clean.

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Correct Answer is B

Explanation

A. Major depressive disorder can affect bowel habits, but it is more commonly associated with constipation rather than diarrhea.

B. Stress, such as that experienced by the 21-year-old female with multiple final exams, can lead to gastrointestinal symptoms like diarrhea due to the effect of stress hormones on the digestive system.

C. Ignoring the urge to defecate typically leads to constipation rather than diarrhea.

D. Older adults are at risk for constipation due to reduced intestinal motility rather than diarrhea, unless they are taking medications that can cause diarrhea.

A. Immediately before the client has a meal B. After the client feels abdominal cramping C. Every 2 hr while the client is awake D. When the client has the urge to defecate

Correct Answer is D

Explanation

A. Taking the client to the toilet immediately before a meal does not correlate with the natural timing of defecation.

B. Abdominal cramping may indicate constipation or other issues, but waiting for cramping is not part of bowel training.

C. Taking the client to the toilet every 2 hours may not align with the client’s natural bowel habits.

D. The goal of bowel training is to help the client recognize and respond to the urge to defecate, promoting regular bowel habits and reducing incontinence.

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A nurse is planning care for a client who is confined to bed. Which of the following actions should the nurse include in the plan?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which patient is most at risk for diarrhea?

Correct Answer is B

Explanation

A nurse is implementing a bowel training program for a client. For the program to be effective, the nurse should take the client to the toilet at which of the following times?

Correct Answer is D

Explanation

A nurse is teaching a newly licensed nurse about physiological changes in the digestive system that occur with aging. The nurse should include older adults might experience which of the following physiological changes?

A nurse is caring for a client who is postoperative following abdominal surgery. Which of the following findings should indicate to the nurse the client's peristalsis is returning?

A nurse is providing teaching to a client who takes opioid pain medication and has a new prescription for docusate sodium. Which of the following statements by the client indicates an understanding of the teaching?

A patient with a hip fracture is having difficulty defecating into a bedpan while lying in bed. Which action by the nurse will assist the patient in having a successful bowel movement?

A nurse is preparing a teaching plan for a client who has chronic constipation secondary to irregular bowel habits. Which of the following should the nurse plan to include in the teaching?

A nurse is assessing a client who has had staples removed from an abdominal wound postoperatively. The nurse notes a wide separation of the wound edges with light serosanguineous drainage. Which of the following actions should the nurse perform first?

A nurse is teaching a client about foods and beverages that can cause diarrhea. Which of the following should the nurse include in the teaching?

A nurse is teaching a client about nutritional requirements necessary to promote wound healing. Which of the following nutrients should the nurse include in the teaching?