An adult woman with Grave's disease is admitted with severe dehydration and malnutrition. She is currently restless and refusing to eat. Which action is most important for the nurse to implement?

Keep room temperature cool.

Determine the client's food preferences.

Maintain a patent intravenous site.

Teach the client relaxation techniques.

Answer and Explanation

The Correct Answer is C

Choice A reason: Keeping the room temperature cool may help with comfort but is not the immediate priority.

Choice B reason: Determining the client's food preferences is important for nutritional management but is not the first action to take.

Choice C reason:

The correct answer is c) because maintaining a patent intravenous site is crucial for administering fluids and medications to address severe dehydration and malnutrition.

Choice D reason: Teaching relaxation techniques can help with restlessness but is not the most immediate concern.

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Correct Answer is C

Explanation

Choice A reason: While chicken and rice are healthy, they do not specifically address the benefits of fiber in cancer prevention.

Choice B reason: Lean beef is not recommended for reducing the risk of colon cancer, although salads and baked potatoes are healthy choices.

Choice C reason:

The correct answer is c) because oatmeal, raisins, and fruit with skin are high in fiber, which can help reduce the risk of colon and rectal cancers.

Choice D reason: Potatoes and low-fat breads are healthy but do not provide as much fiber as oatmeal, raisins, and fruit with skin.

A. Assess the extremity reflexes. B. Logroll to change positions. C. Immobilize the head in anatomical alignment. D. Obtain hourly neurological assessments.

Correct Answer is C

Explanation

Choice A reason: Assessing the extremity reflexes is important for evaluating neurological function but is not the immediate priority.

Choice B reason: Logrolling to change positions is a technique used to maintain spinal alignment, but it is not the first intervention to ensure immediate safety.

Choice C reason:

The correct answer is c) because immobilizing the head in anatomical alignment is crucial to prevent further injury to the spinal cord. Proper immobilization helps stabilize the cervical spine and protects the spinal cord from additional damage.

Choice D reason: Obtaining hourly neurological assessments is important for monitoring the client's condition but comes after ensuring the cervical spine is properly immobilized.

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An adult woman with Grave's disease is admitted with severe dehydration and malnutrition. She is currently restless and refusing to eat. Which action is most important for the nurse to implement?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which group of foods is best for the nurse to recommend for clients with a strong family history of colon and rectal cancers?

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Correct Answer is C

Explanation

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