A nurse is providing teaching for a client who has constipation-predominant irritable bowel syndrome (IBS-C). Which of the following statements should the nurse include in the teaching?

"Take a dose of loperamide each morning."

"Increase your fluid intake to 1,000 milliliters per day."

"Take psyllium in the evening."

"Consume a diet that is low in protein."

Answer and Explanation

The Correct Answer is C

Rationale:
A. "Take a dose of loperamide each morning.": Loperamide is an antidiarrheal medication and is not appropriate for clients with constipation-predominant IBS (IBS-C). Using loperamide in these clients could worsen constipation.

B. "Increase your fluid intake to 1,000 milliliters per day.": A daily fluid intake of 1,000 milliliters (1 liter) is typically insufficient. Adequate hydration is essential for managing constipation, and clients are generally encouraged to consume at least 6 to 8 glasses (approximately 1.5 to 2 liters) of water daily to help soften stools and promote regular bowel movements.

C. "Take psyllium in the evening.": Psyllium is a soluble fiber supplement that can help alleviate constipation by increasing stool bulk and promoting bowel movements. Taking psyllium in the evening is appropriate, but it is crucial to take it with a full glass of water and maintain adequate hydration throughout the day to prevent potential side effects like bloating or gas.

D. "Consume a diet that is low in protein.": There is no specific recommendation for a low-protein diet in managing IBS-C. Dietary modifications for IBS-C typically focus on increasing soluble fiber intake and reducing fermentable carbohydrates (FODMAPs) rather than altering protein consumption.

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Correct Answer is D

Explanation

Rationale:
A. A client who is newly diagnosed with type 1 diabetes mellitus and cannot afford insulin: This situation requires case management or social work referral to assist with access to medications and insurance. It does not indicate the need for palliative care, as diabetes is a chronic condition that can be managed effectively with proper support.

B. A client who has Meniere’s disease and cannot safely ambulate due to vertigo: While vertigo significantly affects quality of life, it is not life-limiting. This client would benefit more from physical therapy, home safety evaluation, and symptom management, rather than palliative care services.

C. A client who had a stroke and cannot eat or drink without choking: This client may need speech therapy, nutritional support, or possibly enteral feeding, but not necessarily palliative care unless their overall prognosis is poor or complications are expected to worsen.

D. A client whose medications to manage Parkinson’s disease are no longer effective: Palliative care is appropriate for clients with progressive, life-limiting illnesses like advanced Parkinson’s disease, especially when symptoms can no longer be adequately controlled with standard treatments. It focuses on comfort, quality of life, and support for complex symptom management.

A. BUN 16 mg/dL (10 to 20 mg/dL) B. Urine output 40 mL every hour for 3 hr C. Hct 42% (37% to 47%) D. Surgical drain output 300 mL during an 8-hr shift

Correct Answer is D

Explanation

Rationale:
A. BUN 16 mg/dL (10 to 20 mg/dL): This is a normal blood urea nitrogen level and does not indicate dehydration or fluid volume deficit. Elevated BUN may suggest volume depletion, but this value is within the expected range.

B. Urine output 40 mL every hour for 3 hr: A urine output of 30 mL/hr or greater is considered adequate in most adult clients. Therefore, 40 mL/hr is within acceptable limits and does not suggest fluid volume deficit.

C. Hct 42% (37% to 47%): This hematocrit level falls within the normal range and does not indicate hemoconcentration. Elevated hematocrit could signal dehydration, but this value alone does not support that conclusion.

D. Surgical drain output 300 mL during an 8-hr shift: This is a significant amount of fluid loss postoperatively and can contribute to fluid volume deficit. High drain output following surgery, especially spinal procedures, increases the client's risk for hypovolemia and should be closely monitored.

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A nurse is providing teaching for a client who has constipation-predominant irritable bowel syndrome (IBS-C). Which of the following statements should the nurse include in the teaching?

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