After years of struggling with weight management, a middle-aged adult client is evaluated for gastroplasty.
The client has experienced difficulty with managing diabetes mellitus and hypertension, but is approved for surgery.
Which intervention is most important for the nurse to include in this client’s plan of care?

Observe for signs of depression.

Apply sequential compression stockings.

Monitor for urinary incontinence.

Provide a wide variety of meal choices.

Answer and Explanation

The Correct Answer is A

Choice A rationale

Observing for signs of depression is the most important intervention for the nurse to include in the client’s plan of care. This patient has a history of struggling with weight management, diabetes mellitus, and hypertension, and is now approved for gastroplasty. Weight management surgery can have significant psychological implications, and patients may experience depression or other emotional issues. Identifying signs of depression and providing appropriate support and resources is crucial for the client’s overall well-being and successful outcomes.

Nursing Test Bank

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Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

Choice A rationale

Discussing moving to Hawaii does not necessarily indicate a connection to the client’s current condition. It could be a long-term plan or a dream.

Choice B rationale

Being unemotional when talking about needing to rebuild their house could indicate a coping mechanism or emotional detachment. However, without additional context, it’s difficult to definitively associate this behavior with their current condition.

Choice C rationale

Expressing a desire to be in a quieter area of the unit could indicate that the client is experiencing stress, anxiety, or discomfort in their current environment. This behavior is most likely associated with their current condition as it shows a direct response to their surroundings.

Choice D rationale

Requesting sleeping medication for the night could indicate various issues such as insomnia, anxiety, or other sleep-related disorders. However, without more information about the client’s current condition, it’s not possible to make a direct association.

A. Roast pork, fresh strawberries. B. Roasted turkey, canned vegetables. C. Baked potato with skin, raw carrots. D. Pancakes, whole-grain cereals.

Correct Answer is B

Explanation

Choice A rationale

Roast pork is a protein source and does not contribute to fiber content. However, fresh strawberries are high in fiber and may not be suitable for a low-fiber diet.

Choice B rationale

Roasted turkey is a good source of protein and does not contribute to fiber content. Canned vegetables are typically lower in fiber than their fresh or frozen counterparts because the canning process tends to degrade some of the fiber. Therefore, this food selection indicates that the patient understands the prescribed low-fiber diet.

Choice C rationale

Both baked potatoes with skin and raw carrots are high in fiber. The skin of the potato and raw carrots contain insoluble fiber, which may not be suitable for a patient with ulcerative colitis on a low-fiber diet.

Choice D rationale

Pancakes made from refined flour can be part of a low-fiber diet. However, whole-grain cereals are high in fiber and may not be suitable for a patient with ulcerative colitis on a low-fiber diet.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which client statement or behavior is most likely associated with their current condition?

Correct Answer is C

Explanation

A healthcare provider prescribes a low-fiber diet for a patient with ulcerative colitis.Which food selection by the patient indicates to the nurse that the patient understands the prescribed diet?

Correct Answer is B

Explanation

When conducting diet teaching for a client who was diagnosed with hypertension, which food(s) should the nurse encourage the client to eat? Select all that apply.

The charge nurse observes a new nurse preparing to irrigate an intravenous catheter.The new nurse has a luer-lock tipped syringe.What action should the charge nurse take?

What nursing interventions are appropriate for a client starting clonazepam? Select all that apply.

An older adult client with dementia is refusing to allow an unlicensed assistive personnel (UAP) to assist in bathing.The client is becoming increasingly agitated and stating the UAP “wants to hurt me and tie me up.”. Which approach should the nurse use with this client?

Which client statements require follow-up teaching by the nurse? Select all that apply.

The nurse is preparing discharge instructions for a patient with type 2 diabetes mellitus who will be starting exenatide.What information should be included in the discharge instructions?

A patient with primary hypothyroidism is showing early signs of myxedema coma. In what order should the nurse perform the following assessments? (Rank the first action at the top with the remainder in descending order.)